TABLE 4. Presenting signs, symptoms, and laboratory test results associated with meningitis for adults with systemic or cutaneous anthrax.
| Symptom/Sign/Laboratory test result | Patient population |
||
|---|---|---|---|
| Systemic anthrax*,† (N = 419) |
Cutaneous anthrax†,§ (N = 182) |
Cutaneous anthrax¶ (N = 126) |
|
|
Time frame
|
1880–2018 |
1950–2018 |
2005–2012 |
|
Symptom
| |||
| Fever/chills |
X |
X |
X |
| Nausea/vomiting |
X |
X |
X |
| Headache |
X |
X |
X |
| Abdominal pain |
ANA |
X |
ANA |
|
Sign
| |||
| Evidence of coagulopathy (i.e., bleeding) |
ANA |
X |
NE |
|
Vital sign
| |||
| Fever (>38.0°C) |
ANA |
ANA |
X |
| Tachycardia (>90 beats per minute) |
NE |
ANA |
NE |
| Tachycardia (≥100 beats per minute) |
ANA |
NE |
X |
| Tachypnea (>20 breaths per minute) |
ANA |
ANA |
X |
| Systolic hypertension (≥130 mm Hg) |
NE |
NE |
X |
| Diastolic hypertension (≥90 mm Hg) |
NE |
NE |
X |
| Fulminant |
X |
NE |
NE |
|
Dermatologic
| |||
| Lymphadenopathy |
NE |
X |
NE |
| Thoracic edema |
ANA |
X |
ANA |
| Malignant pustule edema |
ANA |
X |
ANA |
|
Neurologic
| |||
| Altered mental status |
X |
ANA |
ANA |
| Meningeal signs |
X |
NE |
NE |
| Nonheadache, nonmeningeal neurologic signs |
X |
X |
NE |
|
Diagnostic laboratory test result
| |||
| Bacteremia at presentation |
ANA |
ANA |
X |
| Bacteremia at any time throughout hospitalization | ANA | X | NE |
Abbreviations: ANA = analyzed and not associated; NE = not evaluated; X = predictive of meningitis.
* Source: Binney S, Person MK, Traxler RM, Cook R, Bower WA, Hendricks K. Algorithms for the identification of anthrax meningitis during a mass casualty event based on a systematic review of systemic anthrax from 1880 through 2018. Clin Infect Dis 2022;75(Suppl 3):S468–77.
† Results from Binney et al. and Thompson et al. shared overlapping data sets.
§ Source: Thompson JM, Cook R, Person MK, et al. Risk factors for death or meningitis in adults hospitalized for cutaneous anthrax, 1950–2018: a systematic review. Clin Infect Dis 2022;75(Suppl 3):S459–67.
¶ Source: Kutmanova A, Zholdoshev S, Roguski KM, et al. Risk factors for severe cutaneous anthrax in a retrospective case series and use of a clinical algorithm to identify likely meningitis and evaluate treatment outcomes, Kyrgyz Republic, 2005–2012. This patient population included one patient aged <18 years with different cutoffs for abnormal vital signs (i.e., >38.5°C for fever, >110 beats per minute for tachycardia, and >14 breaths per minute for tachypnea).