Letters to the Editor

Differential Diagnosis of Acute Inhalation Anthrax



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Am Fam Physician. 2002 May 1;65(9) Online.

to the editor: Unfortunately, in cases such as those outlined in the "Photo Quiz" item entitled "A Widened Mediastinum,"1 acute inhalation anthrax infection must now, unarguably, be added to the differential diagnosis for the cause of acute descending necrotizing mediastinitis.

Drs. Bhargava and Iqbal state that a review of the literature revealed only 69 cases of acute descending necrotizing mediastinitis between 1960 and 1995.2 Just as in necrotizing mediastinitis, a characteristic finding on computed tomographic scan associated with hemorrhagic mediastinitis is symmetric mediastinal widening.3 The clinical presentation of the patient in the “Photo Quiz” was described as initial symptoms of mild upper respiratory tract infection progressing to frank respiratory distress within a timeframe of three to four days—a scenario that is also indicative of acute inhalation anthrax infection.4,5

As I write this letter, I have just learned that two postal workers in Washington, D.C., have died of acute inhalation anthrax.

REFERENCES

1. Bhargava A, Iqbal Z. A widened mediastinum. [Photo Quiz] Am Fam Physician 2001;64:1237-8.

2. Corsten MJ, Shamji FM, Odell PF, Frederico JA, Laframboise GG, Reid KR, et al. Optimal treatment of descending necrotising mediastinitis. Thorax 1997;52:702-8.

3. Knudson GB. Treatment of anthrax in man: history and current concepts. Mil Med 1986;151:71-7.

4. Arnold Kaufman, MD, Acting Chief of Mycotic Diseases, CDC, Atlanta as a quote from Medical Tribune, Feb 7, 1991, “How Biochemical Weapons Work.”

5. Brachman PS. Inhalation anthrax. Ann N Y Acad Sci 1980;353:83-93.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.



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