New Study Distinguishes Anthrax from Flu in Event of Bioterrorist Attack
edited by Herman Rosen, M.D.

Doctors in the Department of Public Health at Weill Cornell Medical Center have identified key symptoms that may help distinguish flu and other common respiratory conditions from more serious inhaled anthrax in the event of a bioterrorist attack. Anthrax is an infectious disease caused by spore-forming bacteria. Inhalation of anthrax leads to disease that, without proper treatment, can cause death from a combination of shock and respiratory failure.

The study, published in the Annals of Internal Medicine, found that while both anthrax and common respiratory conditions presented with symptoms such as fever and cough, other symptoms—such as the neurologic symptoms of loss of consciousness, dizziness, and confusion; serious gastrointestinal symptoms like nausea and vomiting; and shortness of breath—were much more common in patients with inhaled anthrax. Conversely, sore throat and runny nose more often indicated viral infection rather than bacterial anthrax.

“In the case of bioterrorist attack, it is vitally important that physicians’ offices and hospital emergency departments accurately diagnose anthrax, especially considering that laboratory or radiographic testing would not be feasible if there were a high volume of potential cases,” said lead study author Dr. Nathaniel Hupert. “Four of the 11 patients who developed anthrax in 2001 were originally sent home with diagnoses of a viral syndrome, bronchitis, or gastroenteritis.”

The new evidence-based pre-hospital screening anthrax protocol will help physicians more rapidly and accurately identify both potential cases and likely non-cases, thus preserving scarce hospital capacity while ensuring that patients receive appropriate medical care. Dr. Hupert and co-authors Drs. Mushlin, Callahan and Bearman compared the features of anthrax-related illness with more than 4,000 cases of common viral respiratory infections that could mimic or obscure the diagnosis of anthrax infection.

This study was funded by the Agency for Healthcare Research and Quality of the U.S. Dept. of Health and Human Services as part of its bioterrorism preparedness portfolio.#

Dr. Rosen is Clinical Professor of Medicine at Weill Medical College of Cornell University.

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