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Volume 23, Number 1—January 2017

CME ACTIVITY - Research

Analysis of Anthrax Immune Globulin Intravenous with Antimicrobial Treatment in Injection Drug Users, Scotland, 2009–2010

Xizhong Cui1, Leisha D. Nolen1, Junfeng Sun, Malcolm Booth, Lindsay Donaldson, Conrad P. Quinn, Anne E. Boyer, Katherine A. Hendricks, Sean Shadomy, Pieter Bothma, Owen Judd, Paul McConnell, William A. Bower, and Peter Q. EichackerComments to Author 
Author affiliations: National Institutes of Health, Bethesda, Maryland, USA (X. Cui, J. Sun, P.Q. Eichacker); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (L.D. Nolen, C.P. Quinn, A.E. Boyer, K. Hendricks, S. Shadomy, W.A. Bower); Glasgow Royal Infirmary, Glasgow, UK (M. Booth, L. Donaldson); James Paget University Hospital, Norfolk, UK (P. Bothma); Royal Derby Hospital, Derby, UK (O. Judd); Crosshouse Hospital, Kilmarnock, UK (P. McConnell)

Main Article

Table 1

Clinical criteria for administering anthrax immune globulin intravenous during an outbreak of anthrax in injection drug users, Scotland, UK, 2009–2010

Criteria
1. Systemic illness in a heroin user with >1 of the following:
 a. Severe cellulitis, especially accompanied by substantial soft tissue edema
 b. Sudden onset of sepsis with no other obvious source
 c. Meningitis, which might also be characterized by subarachnoid hemorrhage
 d. Respiratory symptoms (suspect inhalational anthrax)
 e. Gastrointestinal symptoms (suspect gastrointestinal anthrax);
OR
2. Features clinically compatible with cutaneous, inhalation, or gastrointestinal illness with systemic effects (including malaise, myalgias, or fever).
In addition to 1 or 2:
Laboratory confirmation by isolation or visualization of a gram-positive bacillus consistent with Bacillus anthracis from blood, tissue, or a normally sterile site or other laboratory-confirmed evidence of anthrax infection after discussion with a local microbiologist or the Special Pathogens Reference Laboratory, Health Protection Agency, Porton Down, UK;
AND
An epidemiologic link to a documented anthrax exposure (such as being a heroin injecting drug user).

Main Article

1These authors contributed equally to this article.

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