Clinical Recognition and Management of Patients Exposed to Biological Warfare Agents

Anthrax as a biological weapon: Medical and public health management

“…While this is a remarkable finding that would permit an astute clinician or microbiologist to make the diagnosis, the widespread use of automated cell-counter technology in diagnostic laboratories makes this unlikely. 41 The most useful microbiologic test is the standard blood culture, which should show growth in 6 to 24 hours. If the laboratory has been alerted to the possibility of anthrax, biochemical testing and review of colonial morphology should provide a preliminary diagnosis 12 to 24 hours later.…”

“…58,59 Most naturally occurring anthrax strains are sensitive to penicillin, and penicillin historically has been the preferred therapy for the treatment of anthrax. Penicillin is approved by the FDA for this indication, 41,56,57 as is doxycycline. 60 In studies of small numbers of monkeys infected with susceptible strains of B anthracis, oral doxycycline has proved efficacious.…”

“…Although treatment of anthrax infection with ciprofloxacin has not been studied in humans, animal models suggest excellent efficacy. 28,41,61 In vitro data suggest that other fluoroquinolone antibiotics would have equivalent efficacy in treating anthrax infection, although no animal data exist for fluoroquinolones other than ciprofloxacin.…”

“…Other patients progressed directly to the second, fulminant stage of illness. 2,19,41 This second stage developed abruptly, with sudden fever, dyspnea, diaphoresis, and shock. Massive lymphadenopathy and expansion of the mediastinum led to stridor in some cases.…”

“…In this second stage of illness, cyanosis and hypotension progress rapidly; death sometimes occurs within hours. 2,19,41 The mortality rate of occupationally acquired cases in the United States is 89%, but the majority of cases occurred before the development of critical care units and, in some cases, before the advent of antibiotics.…”