Differentiating Inhalational Anthrax From Other Influenzalike Illnesses in the Setting of a National or Regional Anthrax Outbreak

Abstract

The workup of a febrile patient who presents with an influenza-like illness in the setting of a national or regional anthrax outbreak presents a unique challenge to the physicians who initially evaluate this patient, and the diagnostic challenge can be even more profound during the influenza season. Based on information gathered from the recent inhalational anthrax cases, we have developed an algorithm to be used by physicians in the emergency department to evaluate patients with influenza-like illnesses during a national or regional anthrax outbreak. The algorithm necessitates stays no longer than 24 hours in the emergency department or hospital.

The Cost-Effectiveness of Strategies to Reduce Mortality from an Intentional Release of Aerosolized Anthrax Spores

“…Infection was assumed to begin immediately at the time of exposure. Once infected, a person may progress through 3 clinical stages of disease: 1) the asymptomatic stage; 2) a prodromal stage characterized by flu-like symptoms that are mild, have extremely low specificity for anthrax, and are normally treated on an outpatient basis 15,16 ; and 3) a fulminant stage characterized by symptoms that are severe, are more suggestive of a diagnosis of inhalational anthrax (symptoms such as hypotension and shortness of breath), and usually require hospitalization. 3,11,[17][18][19] An infected person may or may not die, depending on the severity of disease and on whether postexposure prophylaxis or treatment is given.…”

“…Vaccination increased the number of deaths to 45 because although there were fewer deaths caused by anthrax (15), there were 30 additional deaths caused by vaccine toxicity. An ESR system decreased the number of deaths overall to 14, with the decrease attributable to increased surveillance rather than more rapid response.…”

Communicable Respiratory Threats in the ED: Tuberculosis, Influenza, SARS, and Other Aerosolized Infections

“…Therefore, it is recommended that physicians be aware of both local and national epidemiologic data to determine if influenza is in a particular community, and then have a low index of suspicion for consideration of this disease [46]. With increasing concern about other acute communicable respiratory illnesses, emergency physicians should also be aware of new and evolving algorithms that may help clinicians differentiate common influenza from avian influenza, SARS, anthrax, or other emergent biothreats [48].…”