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Volume 20, Number 9—September 2014
CME ACTIVITY - Synopsis

Confirmed Bacillus anthracis Infection among Persons Who Inject Drugs, Scotland, 2009–2010

Malcolm Booth1, Lindsay Donaldson1, Xizhong Cui, Junfeng Sun, Stephen Cole, Susan Dailsey, Andrew Hart, Neil Johns, Paul McConnell, Tina McLennan, Benjamin Parcell, Henry Robb, Benjamin Shippey, Malcolm Sim, Charles Wallis, and Peter Q. EichackerComments to Author 
Author affiliations: Glasgow Royal Infirmary, Glasgow, Scotland, UK (M. Booth, L. Donaldson, A. Hart); National Institutes of Health, Bethesda, Maryland, USA (X. Cui, J. Sun, P.Q. Eichacker); Ninewells Hospital, Dundee, Scotland, UK (S. Cole, B. Parcell); Victoria Infirmary, Glasgow (S. Dailsey); Queen Margaret and Victoria Hospitals, Dumfermline, Scotland, UK (N. Johns, B. Shippey); Crosshouse Hospital, Kilmarnock, Scotland, UK (P. McConnell); Hairmyres Hospital, East Kilbride, Scotland, UK (T. McLennan); Forth Valley Royal Hospital, Larbert, Scotland, UK (H. Robb); Western Infirmary, Glasgow (M. Sim); Western General Hospital, Edinburgh, Scotland, UK (C. Wallis)

Main Article

Table 2

Clinical and laboratory findings, confirmatory laboratory results, and therapies administered during hospitalization of persons who inject drugs and had Bacillus anthracis infection, Scotland, UK, 2009–2010*

Finding or test Overall* Survivor Nonsurvivor
Skin/limb findings
Localized edema 22/24 (92) 14/15 (93) 8/9 (89)
Local pain 19/21 (90) 14/15 (93) 5/6 (83)
Local erythema 20/24 (83) 13/16 (81) 7/8 (88)
Skin lesion 19/26 (73) 11/16 (69) 8/10 (80)
Limb pain 12/22 (55) 10/16 (63) 2/6 (33)
Limb edema 13/25 (52) 10/16 (63) 3/9 (33)
Limb mottling 10/24 (42) 5/15 (33) 5/9 (56)
Exudate 5/22 (23) 4/16 (25) 1/6 (17)
Distant edema 4/21 (19) 3/13 (23) 1/8 (13)
Ulcer 4/23 (17) 3/15 (20) 1/8 (13)
Eschar
 4/24 (17)
 3/16 (19)
 1/8 (13)
Chemistry, hematology, and arterial blood gas results (reference)†
Potassium, mmol/L (3.5–5.3 mmol/L) 4.2 + 0.2 3.9 + 0.1 4.5 + 0.4
Chloride, mmol/L (96–108 mmol/L) 98 + 2 101 + 2 95 + 3
Creatinine, μmol/L (40–130 μmol/L) 108 + 14 93.4 + 16.1 130 + 24
Blood urea nitrogen, mmol/L (2.5–7.8 mmol/L) 8.3 + 1.6 7.3 + 2.5 9.8 + 1.7
Glucose, mmol/L (3.6–6.0 mmol/L) 8.9 + 1.0 7.3 + 1.4 10.4 + 1.2
Alkaline phosphatase, U/L (30–130 U/L) 113 + 14 106 + 15 121 + 27
Alanine aminotransaminase, U/L (<50 U/L) 44 + 15 53 + 33 37 + 6
Total protein, g/L (60–80 g/L) 61 + 3 65 + 3 55 + 5
Leukocyte × 109/L (4–11 × 109/L) 16.7 + 1.5 14.7 + 1.5 18.3 + 2.8
Lymphocyte, % (18%–44%) 0.15 + 0.02 0.16 + 0.03 0.13 + 0.02
Fibrinogen, g/L (2–4.10 g/L) 1.8 + 0.2 2.0 + 0.4 1.5 + 0.2
Hydrogen ion concentration, nmol/L (35–50 nmol/L) 43 + 2 40 + 3 45 + 3
PaO2, kPa (9–20 kPa) 21 + 3 18 + 4 23 + 4
PaCO2, kPa (3.5–6.5 kPa) 5.1 + 0.5 6.0 + 0.5 4.6 + 0.5
Lactate, mmol/L (<2 mmol/L)
 3.8 + 1.0
 1.7 + 0.4
 5.2 + 1.5
Confirmatory laboratory results
Blood culture 14/26 (54) 7/15 (47) 7/11 (64)
Wound culture 4/12 (33) 4/10 (40) 0/2 (0)
Tissue culture 10/14 (71) 5/8 (63) 5/6 (83)
PCR 12/20 (60) 5/12 (42) 7/8 (88)
Protective antigen antibody test 12/17 (71) 9/11 (82) 3/6 (50)
Lethal factor antibody test 10/18 (56) 8/12 (67) 2/6 (33)
Protective antigen ELISA 10/15 (67) 5/10 (50) 5/5 (100)
Lethal factor ELISA 8/13 (62) 4/9 (44) 4/4 (100)
Tissue Immunohistochemistry
 3/3 (100)
 2/2 (100)
 1/1 (100)
Therapies administered
Packed erythrocytes 13/22 (59) 7/13 (54) 6/9 (67)
Fresh frozen plasma 13/22 (59) 6/13 (46) 7/9 (78)
Platelets 10/27 (37) 4/16 (25) 6/11 (55)
Cryoprecipitate 3/20 (15) 1/12 (8) 2/8 (25)
Renal replacement therapy 7/26 (27) 3/15 (20) 4/11 (36)
Pleural drainage 4/27 (15) 3/16 (19) 1/11 (9)
Peritoneal drainage 3/25 (12) 0/15 (0) 3/10 (3)

*No. (%) patients noted to have the finding/total no. patients for whom data were provided, except for chemistry, hematology, and arterial blood gas results, for which values are indicated.
†Mean ± SEM.

Main Article

1These authors contributed equally to this article.

Page created: August 15, 2014
Page updated: August 15, 2014
Page reviewed: August 15, 2014
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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