Inhalational, Gastrointestinal, and Cutaneous Anthrax in Children

Abstract

The clinical presentation of children with anthrax is varied. The mortality rate is high in children with inhalational anthrax, gastrointestinal anthrax, and anthrax meningoencephalitis. Rapid diagnosis and effective treatment of anthrax in children requires recognition of the broad spectrum of clinical presentations of pediatric anthrax.

Pediatric Anthrax Clinical Management

“…27 With prompt diagnosis, initiation of combination antimicrobial therapy, and modern critical care, the mortality rate observed in adults with inhalation anthrax dropped from more than 90% for the whole 20th century to 45% in the exposures linked to letters contaminated with B anthracis spores in 2001, 23 which suggests that better outcomes are also likely to occur in children. In 2006 28 and 2011, 29 adults in Pennsylvania and Minnesota, respectively, were successfully treated for naturally acquired inhalation anthrax, demonstrating the effectiveness of modern treatments.…”

“…A report by Bravata et al 27 indicated that the most commonly reported pediatric gastrointestinal anthrax symptoms, in order from most to least common, were fever, abdominal pain, vomiting, diarrhea, and bloody stool.…”

“…All forms of systemic anthrax can progress to me-ningoencephalitis, which, to date, has been nearly always fatal. 7,27 However, there is limited experience with treatment using currently available intensive care. In a systematic review of pediatric anthrax by Bravata et al, 27 meningoencephalitis developed in 7 of 22 patients with gastrointestinal anthrax and 1 of 37 patients with cutaneous anthrax; 6 children had primary meningoencephalitis with no apparent focus of entry.…”

“…In an autopsy series of adult patients from Sverdlovsk, 50% of fatal cases had evidence of meningeal involvement. 33 Signs of meningoencephalitis include fever, altered mental status, meningeal signs, and seizures, 34 although in the review by Bravata et al, 27 pediatric cases of meningoencephalitis presented with fever, headache, delirium, seizures, emesis, and diarrhea. Too few cases exist to provide information on differences in the clinical presentation of meningitis between adults and children.…”

Pathology, Diagnosis, and Treatment of Anthrax in Humans

“…High level of suspicion of a diagnosis of anthrax in cases with unusual exposure histories can make the difference in establishing prompt treatment. Of the three types of anthrax, the cutaneous form is the most frequently encountered in humans and has the lowest mortality rate (approximately 14%), while inhalational and gastrointestinal anthrax occur very rarely but have higher mortality rates (around 60%) (Bravata et al, 2007 ).…”