Clinical predictors of bioterrorism-related inhalational anthrax

Demetrios N. Kyriacou, Adam C. Stein, Paul R. Yarnold, D. Mark Courtney, Regina R. Nelson, Gary A. Noskin, Jonathan A. Handler, Ralph R. Frerichs

Research output: Contribution to journalArticle

32 Scopus citations


Limitation of a bioterrorist anthrax attack will require rapid and accurate recognition of the earliest victims. To identify clinical characteristics of inhalational anthrax, we compared 47 historical cases (including 11 cases of bioterrorism-related anthrax) with 376 controls with community-acquired pneumonia or influenza-like illness. Nausea, vomiting, pallor or cyanosis, diaphoresis, altered mental status, and raised haematocrit were more frequently recorded in the inhalational anthrax cases than in either the community-acquired pneumonia or influenza-like illness controls. The most accurate predictor of anthrax was mediastinal widening or pleural effusion on a chest radiograph. This finding was 100% sensitive (95% CI 84·6-100·0) for inhalational anthrax, 71·8% specific (64·8-78·1) compared with community-acquired pneumonia, and 95·6% specific (90·0- 98·5) compared with influenza-like illness. Our findings represent preliminary efforts toward identifying clinical predictors of inhalational anthrax.

Original languageEnglish (US)
Pages (from-to)449-452
Number of pages4
Issue number9432
StatePublished - Jul 31 2004
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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    Kyriacou, D. N., Stein, A. C., Yarnold, P. R., Mark Courtney, D., Nelson, R. R., Noskin, G. A., Handler, J. A., & Frerichs, R. R. (2004). Clinical predictors of bioterrorism-related inhalational anthrax. Lancet, 364(9432), 449-452.