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Volume 8, Number 10—October 2002
Bioterrorism-related Anthrax
Bioterrorism-related Anthrax

Epidemiologic Investigations of Bioterrorism-Related Anthrax, New Jersey, 2001

Carolyn M. Greene*Comments to Author , Jennita Reefhuis*, Christina Tan*, Anthony E. Fiore*, Susan Goldstein*, Michael J. Beach*, Stephen C. Redd*, David Valiante, Gregory A. Burr*, James W. Buehler*, Robert W. Pinner*, Eddy Bresnitz, Beth P. Bell*, and the CDC New Jersey Anthrax Investigation Team
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA;

Main Article

Table 3

Clinical findings in two patients with bioterrorism-related inhalational anthrax, New Jersey, September–October 2001a

Clinical finding Case 1 Case 2
Past medical history Transient ischemic attack None
Smoking status Nonsmoker Nonsmoker
Initial symptoms Fever, chills, vomiting, diarrhea Fever, chills, vomiting, dry cough, headache
Signs at ER visit Fever: temp=38.4°C; Tachycardia: HR=120/min; Hypoxia: arterial paO2=58 (RA) Fever: temp=38.4°C;
Tachycardia: HR=120/min;
Hypoxia: SaO2=92% (RA)
Chest x-ray Infiltrate, pleural effusion Infiltrate, pleural effusion
Hospital course Re-accumulating hemorrhagic pleural effusions Re-accumulating hemorrhagic pleural effusions
Laboratory results
Blood culture Negative (before start of antibiotics) Negative (after 2 days of antibiotics)
Blood positive for Bacillus anthracis by PCR Yes (before start of antibiotics) No (after 2 days of antibiotics)
IHC staining of pleural fluid
Cytology Positive for B. anthracis cell wall
Positive for B. anthracis capsule Positive for B. anthracis cell wall
Positive for B. anthracis capsule
Convalescent-phase serumb Anti-PA IgG antibodies present Anti-PA IgG antibodies present

aER, emergency room; HIC, immunohistochemical; PCR, polymerase chain reaction; Anti-PA IgG, anti-protective antigen immunoglobulin G.
bConvalescent-phase serum is serum drawn at least 14 days after symptoms begin.

Main Article

1 The CDC New Jersey Anthrax Investigation Team consists of Paul P. Abamonte, Chidinma Alozie-Arole, Gregory Armstrong, Sherrie Bruce, Shadi Chamany, Diane Crawford, Donita R. Croft, Colleen Crowe, Stephanie I. Davis, George DiFerdinando, Catherine Dentinger, Deborah A. Deppe, Mary Dillon, Mary Dott, Leigh A. Farrington, Michael Fraser, Dara S. Friedman, Jessica Gardom, Carol Genese, Dawn Gnesda, Rita Helfand, Beth C. Imhoff, Greg J. Jones, Renee Joskow, Pavani Kalluri, Sean G. Kaufman, Melody Kawamoto, Malinda Kennedy, Jonathon D. King, Susan McClure, Michelle McConnell, Peter D. McElroy, Kenneth R. Mead, Suzanne Miro, R. Leroy Mickelsen, Jeff Nemhauser, Mita Patel, Cindi Pecoraro, Marion Pierce, Lisa Roth-Edwards, Hardeep Sandhu, Donald Schill, Michael Sells, Nicole Tucker, Reuben Varghese, Daniel J. Yereb, and Juan Zubieta.

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