Field identification of anthrax cases could save lives after an aerosol attack with Bacillus anthracis spores
A brief, evidence-based checklist covering symptoms and signs of anthrax may help to rapidly distinguish anthrax from other conditions with minimal need for diagnostic testing after known or suspected population exposure. The checklist is described in an article published in Annals of Internal Medicine.
Few health emergencies would rival the medical consequences of a wide-area aerosol attack with Bacillus anthracis spores, the causative agent of anthrax, over a populated area. Even with modern critical care, almost half of the patients would die. To save as many lives as possible, rapidly separating anthrax cases from other illnesses would be crucial, and laboratory-based mass screening of the affected population would take too much time. Having evidence-based triage algorithms that could be used in the field may mean the difference between life and death.
Researchers from the Centers for Disease Control and Prevention (CDC) developed a field-deployable checklist that rapidly distinguishes most anthrax from nonanthrax illnesses on the basis of clinical presentation. To develop the checklist, the authors reviewed published literature from 1880 to 2013 to compare the clinical presentations of adult patients with anthrax to those of persons presenting for evaluations at two epicenters of the 2001 U.S. anthrax attacks. Their checklist-directed triage without diagnostic testing correctly classified 95 percent of 353 adult anthrax cases and 76 percent of 647 control patients. They also found that their checklist sensitivity and specificity were minimally affected by the inclusion of pediatric patients. Sensitivity increased to 97 percent and 98 percent respectively when only inhalation anthrax cases or higher-quality case reports were investigated.