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Update in Infectious Diseases
2002-2003 Series: Update Sessions from ACP-ASIM's 2002 Annual Session
David A. Cramer, MD, and Paul T. Kefalides, MD, Co-Editors
A look at the medical literature from 2001 affirms that infectious diseases remains one of the most changeable and exciting areas of clinical practice. The papers I review in this Update cover terrorist threats to the public health, new approaches to some old problems, newly recognized disorders and novel treatments for infection, HIV infection, and infectious complications of treatment for other illnesses.
Biological Terrorism
Bioterrorism in the United States is no longer merely a threat but a reality; Americans ask not “What if?” but “What next?” Bioterrorism, as distinct from biological warfare, is an attempt not so much to kill and incapacitate but to cause panic and disrupt daily life. To date, 7 cases of cutaneous anthrax and 11 cases of inhalational anthrax from terrorist activity have been confirmed.
The Unthinkable Happens: The Initial Cases of Terrorism-Related Inhalational Anthrax
Eight of the first 10 victims of inhalational anthrax were postal workers exposed when they processed letters containing spores of Bacillus anthracis. After a 4- to 6-day incubation period, the victims developed fever, chills, fatigue, and malaise and often had drenching sweats and a nonproductive cough. Severe dyspnea, nausea, vomiting, and pleuritic pain were frequent. Many patients had elevated liver enzyme levels and were hypoxic. Chest radiographs were consistently abnormal, showing a widened mediastinum, infiltrates, and pleural effusion. Seven patients had positive blood cultures. With multidrug antimicrobial therapy and supportive care, 6 of the 10 patients survived.
Most patients had an increase in neutrophil counts or the number of immature neutrophils. Every patient had pleural effusion within 24 hours of presentation. An initial nonspecific phase was followed within 3 days or less by rapidly worsening shortness of breath, stridor, and sometimes stupor.
Up to half of patients with anthrax develop hemorrhagic meningitis, and …
