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Volume 7, Number 6—December 2001

Research

Bioterrorism-Related Inhalational Anthrax: The First 10 Cases Reported in the United States

John A. Jernigan*Comments to Author , David S. Stephens*†, David A. Ashford*, Carlos Omenaca‡, Martin S. Topiel§, Mark Galbraith¶, Michael Tapper#, Tamara L. Fisk*†, Sherif R. Zaki*, Tanja Popovic*, Richard F. Meyer*, Conrad P. Quinn*, Scott A. Harper*, Scott K. Fridkin*, James J. Sejvar*, Colin W. Shepard*, Michelle McConnell*, Jeannette Guarner*, Wun-Ju Shieh*, Jean M. Malecki**, Julie L. Gerberding*, James M. Hughes*, Bradley A. Perkins*, and members of the Anthrax Bioterrorism Investigation Team

Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Emory University School of Medicine, Atlanta, Georgia, USA; ‡Cedars Medical Center, Miami, Florida, USA; §Virtua Health, Mount Holly, New Jersey, USA; ¶Winchester Medical Center, Winchester, Virginia, USA; #Lenox Hill Hospital, New York City, New York, USA; **Palm Beach County Department of Public Health, West Palm Beach, Florida, USA

Article in French

Main Article

Table 1

Laboratory findings at initial visit to health-care provider for 10 patients with bioterrorism-related inhalational anthrax, October through November 2001

Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Case 8 Case 9a Case 10
WBC/mm3b 9,400 9,900 7,500 9,700 10,300 13,300 9,700 8,100 11,200 11,400
WBC differential
Neutrophils % 76 72 76 43 83 78 79 50 67 83
Band forms % ND ND 8 10 4 ND ND 6 14 ND
Lymphocytes% 15 10 7 24 6 11 14 30 8 9
Monocytes% 9 17 7 15 7 8 7 10 11 7
Hematocrit % 45.7 47.1 46.9 48.6 43.0 51.4 44.7 45.3 42.5 46.3
Platelet count x 103/mm3 109 WNL WNL WNL WNL WNL WNL WNL WNL WNL
Sodium mmol/L 132 WNL WNL WNL ND WNL 134 133 133 134
Potassium mmol/L WNL WNL WNL WNL ND WNL 3.4 WNL WNL WNL
Chloride mmol/L WNL WNL WNL WNL ND WNL WNL 98 WNL WNL
Bicarbonate mmol/L WNL WNL WNL WNL ND WNL 20 WNL WNL WNL
Creatinine mg/dL WNL 1.2 WNL WNL ND WNL WNL WNL WNL WNL
SGOT IU/L WNL 405 106 153 ND WNL ND 269 130 240
SGPT IU/L WNL 408 123 184 ND 44 ND 168 120 263
Alkaline phosphatase IU/L WNL 141 165 171 ND WNL ND WNL 147 WNL
Albumin g/dL WNL 2.3 2.9 2.9 ND WNL ND WNL 3.4 3.3
Bilirubin mg/dL 1.5 WNL 1.9 1.7 ND WNL ND WNL WNL WNL
Arterial pH 7.32 7.48 7.45 7.46 ND ND ND 7.51 ND 7.41
Arterial PaCO2 mm Hg 37 33 27 38 ND ND ND 26 ND 40
Arterial PaO2 mm Hg (FiO2) 208 52 80 66 ND ND ND 58 ND 122
(70%) (RA) (RA) (RA) (RA) (100% NRBR)
Pleural fluidc
RBC/mm3 ND 110,000 243,586 179,841 ND ND ND 80,000 "Many" 73,000
WBC/mm33(% neutrophils) ND 2,260 (58%) 1,707 (15) 1,633 (6) ND ND ND 785 (12) 286 (71) 3,000 (90)
Protein g/dL ND 2.6 2.7 4.3 ND ND 2.01 4.8 4.1 4.2
LDH IU/L ND 282 1,762 965 ND ND 261 319 740 1,264

a The patient in Case 9 was initially seen as an outpatient 2 days before hospital admission, but had no laboratory studies performed at that time. These results were obtained from studies done on the day of admission.
b WBC = white blood cells; WNL = within normal limits; ND = not done; NA = not available; SGOT = serum glutamic oxalacetic transaminase; SGPT = serum glutamic pyruvic transaminase; FiO2 = fraction of inspired O2; RA = room air; NRBR = nonrebreather mask; RBC = red blood cells; LDH = lactate dehydrogenase
cPleural fluid studies were not performed at the time of the initial visit to a health-care provider.

Main Article

1Members of the team who contributed to the work presented in this manuscript are J. Aguilar, M. Andre, K. Baggett, B. Bell, D. Bell, M. Bowen, G. Carlone, M. Cetron, S. Chamany, B. De, C. Elie, M. Fischer, A. Hoffmaster, K. Glynn, R. Gorwitz, C. Greene, R. Hajjeh, T. Hilger, J. Kelly, R. Khabbaz, A. Khan, P. Kozarsky, M. Kuehnert, J. Lingappa, C. Marston, J. Nicholson, S. Ostroff, T. Parker, L. Petersen, R. Pinner, N. Rosenstein, A. Schuchat, V. Semenova, S. Steiner, F. Tenover, B. Tierney, T. Uyeki, S. Vong, D. Warnock, C. Spak, D. Jernigan, C. Friedman, M. Ripple, D. Patel, S. Pillai, S. Wiersma, R. Labinson, L. Kamal, E. Bresnitz, M. Layton, G. DiFerdinando, S. Kumar, P. Lurie, K. Nalluswami, L. Hathcock, L. Siegel, S. Adams, I. Walks, J. Davies-Coles, M. Richardson, K. Berry, E. Peterson, R. Stroube, H. Hochman, M. Pomeranz, A. Friedman-Kien, D. Frank, S. Bersoff-Matcha, J. Rosenthal, N. Fatteh, A. Gurtman, R. Brechner, C. Chiriboga, J. Eisold, G. Martin, K. Cahill, R. Fried, M. Grossman, and W. Borkowsky.

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