Clinical Features of Patients Hospitalized for All Routes of Anthrax, 1880-2018: A Systematic Review.
anthrax
cutaneous anthrax
ingestion anthrax
inhalation anthrax
injection anthrax
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
17 10 2022
17 10 2022
Historique:
received:
06
05
2022
entrez:
17
10
2022
pubmed:
18
10
2022
medline:
20
10
2022
Statut:
ppublish
Résumé
Anthrax is a toxin-mediated zoonotic disease caused by Bacillus anthracis, with a worldwide distribution recognized for millennia. Bacillus anthracis is considered a potential biowarfare agent. We completed a systematic review for clinical and demographic characteristics of adults and children hospitalized with anthrax (cutaneous, inhalation, ingestion, injection [from contaminated heroin], primary meningitis) abstracted from published case reports, case series, and line lists in English from 1880 through 2018, assessing treatment impact by type and severity of disease. We analyzed geographic distribution, route of infection, exposure to anthrax, and incubation period. Data on 764 adults and 167 children were reviewed. Most cases reported for 1880 through 1915 were from Europe; those for 1916 through 1950 were from North America; and from 1951 on, cases were from Asia. Cutaneous was the most common form of anthrax for all populations. Since 1960, adult anthrax mortality has ranged from 31% for cutaneous to 90% for primary meningitis. Median incubation periods ranged from 1 day (interquartile range [IQR], 0-4) for injection to 7 days (IQR, 4-9) for inhalation anthrax. Most patients with inhalation anthrax developed pleural effusions and more than half with ingestion anthrax developed ascites. Treatment and critical care advances have improved survival for those with systemic symptoms, from approximately 30% in those untreated to approximately 70% in those receiving antimicrobials or antiserum/antitoxin. This review provides an improved evidence base for both clinical care of individual anthrax patients and public health planning for wide-area aerosol releases of B. anthracis spores.
Sections du résumé
BACKGROUND
Anthrax is a toxin-mediated zoonotic disease caused by Bacillus anthracis, with a worldwide distribution recognized for millennia. Bacillus anthracis is considered a potential biowarfare agent.
METHODS
We completed a systematic review for clinical and demographic characteristics of adults and children hospitalized with anthrax (cutaneous, inhalation, ingestion, injection [from contaminated heroin], primary meningitis) abstracted from published case reports, case series, and line lists in English from 1880 through 2018, assessing treatment impact by type and severity of disease. We analyzed geographic distribution, route of infection, exposure to anthrax, and incubation period.
RESULTS
Data on 764 adults and 167 children were reviewed. Most cases reported for 1880 through 1915 were from Europe; those for 1916 through 1950 were from North America; and from 1951 on, cases were from Asia. Cutaneous was the most common form of anthrax for all populations. Since 1960, adult anthrax mortality has ranged from 31% for cutaneous to 90% for primary meningitis. Median incubation periods ranged from 1 day (interquartile range [IQR], 0-4) for injection to 7 days (IQR, 4-9) for inhalation anthrax. Most patients with inhalation anthrax developed pleural effusions and more than half with ingestion anthrax developed ascites. Treatment and critical care advances have improved survival for those with systemic symptoms, from approximately 30% in those untreated to approximately 70% in those receiving antimicrobials or antiserum/antitoxin.
CONCLUSIONS
This review provides an improved evidence base for both clinical care of individual anthrax patients and public health planning for wide-area aerosol releases of B. anthracis spores.
Identifiants
pubmed: 36251560
pii: 6762182
doi: 10.1093/cid/ciac534
pmc: PMC9649428
doi:
Substances chimiques
Aerosols
0
Antitoxins
0
Biological Warfare Agents
0
Heroin
70D95007SX
Types de publication
Journal Article
Systematic Review
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
S341-S353Subventions
Organisme : CDC HHS
Pays : United States
Informations de copyright
Published by Oxford University Press on behalf of Infectious Diseases Society of America 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Références
Science. 1994 Nov 18;266(5188):1202-8
pubmed: 7973702
Cent Afr J Med. 1981 Jun;27(6):101-4
pubmed: 7261058
Clin Infect Dis. 2013 Dec;57(11):e177-81
pubmed: 23994818
Science. 2002 Mar 8;295(5561):1861
pubmed: 11884746
Br Med J. 1952 Jan 12;1(4749):86-7
pubmed: 14896037
Pediatr Dermatol. 2010 Nov-Dec;27(6):600-6
pubmed: 21083757
South Med J. 1959 Jun;52(6):643-9
pubmed: 13659158
Chest. 1992 Jun;101(6):1644-55
pubmed: 1303622
Br Med J. 1929 Oct 12;2(3588):667
pubmed: 20774981
Emerg Infect Dis. 2002 Oct;8(10):1019-28
pubmed: 12396909
J Clin Epidemiol. 2014 Jan;67(1):46-51
pubmed: 24035173
N Engl J Med. 1978 Apr 27;298(17):927-33
pubmed: 642973
Arch Pediatr Adolesc Med. 2007 Sep;161(9):896-905
pubmed: 17768291
Ann Intern Med. 2006 Feb 21;144(4):270-80
pubmed: 16490913
Indian Pediatr. 2001 Jul;38(7):777-9
pubmed: 11463966
Bacteriol Rev. 1961 Sep;25(3):282-4
pubmed: 16350173
Semin Dial. 2014 Jul-Aug;27(4):407-14
pubmed: 24890576
Emerg Infect Dis. 2006 Mar;12(3):523-5
pubmed: 16710982
Ann Trop Paediatr. 2005 Mar;25(1):49-52
pubmed: 15822245
Turk J Emerg Med. 2018 Nov 14;19(2):76-78
pubmed: 31073544
Ann Emerg Med. 2006 Aug;48(2):200-11
pubmed: 16857469
Euro Surveill. 2014 Aug 14;19(32):
pubmed: 25139073
Ann N Y Acad Sci. 1980;353:83-93
pubmed: 7013615
Ann Intern Med. 2019 Apr 16;170(8):521-530
pubmed: 30884525
Health Secur. 2015 Nov-Dec;13(6):355-64
pubmed: 26623698
Pediatr Crit Care Med. 2005 Jan;6(1):2-8
pubmed: 15636651
PLoS Pathog. 2013 Aug;9(8):e1003555
pubmed: 24058320
Can Med Assoc J. 1945 Jun;52(6):592-600
pubmed: 20323461
J Assoc Physicians India. 1981 Jan;29(1):59-62
pubmed: 6790511
Biosecur Bioterror. 2012 Sep;10(3):299-303
pubmed: 22871211
Clin Infect Dis. 2016 Jun 15;62(12):1537-1545
pubmed: 27025833
Med Decis Making. 2008 Jul-Aug;28(4):593-605
pubmed: 18556642
Infect Immun. 2011 Aug;79(8):3204-15
pubmed: 21628518
Obstet Gynecol. 2012 Dec;120(6):1439-49
pubmed: 23168771
Neurology. 2002 Aug 13;59(3):327-34
pubmed: 12177364