Table 2.
Patient Characteristics, Presenting Signs and Symptoms, and Treatments for Patients with Anthrax Meningitis by Fatality Status
| All Meningitis (n = 132) | Died (n = 122) | Lived (n = 10) | OR (95% CI)a | P-value b | |
|---|---|---|---|---|---|
| Patient Characteristic | |||||
| Age (years)c, mean±STD (n) | 38.4±16.4 (127) | 38.6±15.6 (117) | 36.1±24.7 (10) | NA | 0.6 |
| Age 0–12, % (n) | 7 (9) | 5 (6) | 30 (3) | Reference | |
| Age 13–17, % (n) | 8 (10) | 8 (9) | 10 (1) | 4.2 (0.3–261.9) | 0.5 |
| Age 18–50, % (n) | 61 (77) | 65 (76) | 10 (1) | 34.2 (2.4–2018.2) | 0.006 |
| Age >50, % (n) | 24 (31) | 22 (26) | 50 (5) | 2.5 (0.3–18.0) | 0.5 |
| Sex | |||||
| Female, % (n) | 17 (22) | 17 (21) | 10 (1) | Reference | |
| Male, % (n) | 83 (110) | 83 (101) | 90 (9) | 0.5 (0.0–4.3) | >0.9 |
| Symptoms at Presentation | |||||
| Symptom onset to therapy (days), mean±STD (n) | 3.1 ±3.9 (76) | 3.1±4.2 (66) | 2.7±1.3 (10) | NA | 0.8 |
| Fever or chills, % (n) | 78 (103) | 76 (93) | 100 (10) | 0.2 (0.0–1.2) | 0.2 |
| Nausea or emesis, % (n) | 46 (61) | 43 (53) | 80 (8) | 0.2 (0.0–1.0) | 0.06 |
| Fatigue or malaise, % (n) | 31 (41) | 31 (38) | 30 (3) | 1.1 (0.2–6.7) | >0.9 |
| Headache, % (n) | 44 (58) | 41 (50) | 80 (8) | 0.2 (0.0–0.9) | 0.04 |
| Severe headache, % (n) | 20 (26) | 17 (21) | 50 (5) | 0.2 (0.0–1.0) | 0.051 |
| Bleeding (e.g., hematemesis), % (n) | 16 (21) | 17 (21) | 0 (0) | 2.8 (0.6-∞) | 0.3 |
| Dyspnea, % (n) | 18 (24) | 18 (22) | 20 (2) | 0.9 (0.2–9.1) | >0.9 |
| Cough, % (n) | 13 (17) | 11 (14) | 30 (3) | 0.3 (0.1–2.0) | 0.2 |
| Chest Pain, % (n) | 10 (13) | 8 (10) | 30 (3) | 0.2 (0.0–1.5) | 0.1 |
| Clinical Signs at Presentation | |||||
| Arrhythmia, % (n) | 2 (2) | 1 (1) | 10 (1) | 0.1 (0.0–6.5) | 0.3 |
| Neurologic findings | |||||
| Altered mental status, % (n) | 77 (101) | 80 (97) | 40 (4) | 5.7 (1.2–29.8) | 0.02 |
| Loss of consciousness, % (n) | 40 (53) | 42 (51) | 20 (2) | 2.9 (0.5–28.7) | 0.3 |
| Meningeal signsd, % (n) | 40 (49) | 38 (44) | 71 (5) | 0.2 (0.0–1.6) | 0.2 |
| Other neurologic deficitsd, % (n) | 42 (52) | 42 (49) | 43 (3) | 1.0 (0.2–6.9) | >0.9 |
| First Laboratory Results | |||||
| WBCs (×109/L), mean±STD (n) | 19.2±13.0 (44) | 21.0±13.6 (36) | 10.9±4.9 (8) | NA | 0.047 |
| Serum sodium (mmol/L), mean±STD (n) | 134.8 ±10.4 (5) | 133.3±14.0 (3) | 137.0±4.2 (2) | NA | 0.8 |
| Cerebrospinal fluid | |||||
| Hemorrhagic, % (n) | 43 (57) | 46 (56) | 10 (1) | 7.5 (1.0–340.6) | 0.051 |
| Turbid, % (n) | 30 (40) | 30 (37) | 30 (3) | 1.0 (0.2–6.4) | >0.9 |
| RBCs (×109/L), mean±STD (n) | 5.7±8.1 (15) | 7.1±8.6 (12) | 0.4±0.6 (3) | NA | 0.2 |
| WBCs (×109/L), mean±STD (n) | 3.2±2.8 (36) | 3.6±2.8 (30) | 0.9±1.0 (6) | NA | 0.03 |
| Protein (g/L), mean±STD (n) | 6.3±6.3 (42) | 6.5±6.5 (37) | 4.6±5.1 (5) | NA | 0.5 |
| Glucose (mmol/L), mean±STD (n) | 3.1±2.4 (41) | 3.1±2.6 (35) | 2.8±1.7 (6) | NA | 0.8 |
| Subarachnoid hemorrhagee, % (n) | 46 (6) | 50 (6) | 0 (0) | 0.9 (0.0-∞) | >0.9 |
| Treatment | |||||
| Any therapy (antibiotics/antiserum), % (n) | 61 (81) | 58 (71) | 100 (10) | 0.1 (0.0–0.5) | 0.01 |
| Antimicrobial | |||||
| Monotherapy, % (n) | 29 (38) | 29 (35) | 30 (3) | 0.9 (0.2–5.9) | >0.9 |
| Multiple, % (n) | 29 (38) | 25 (31) | 70 (7) | 0.1 (0.0–0.7) | 0.01 |
| Bactericidal, % (n) | 56 (74) | 52 (64) | 100 (10) | 0.1 (0.0–0.4) | 0.005 |
| Penicillin, % (n) | 50 (66) | 48 (58) | 80 (8) | 0.2 (0.0–1.2) | 0.1 |
| Protein synthesis inhibitor, % (n) | 20 (26) | 18 (22) | 40 (4) | 0.3 (0.1–1.7) | 0.2 |
| Serum/Antitoxin therapy, % (n) | 6 (8) | 6 (7) | 10 (1) | 0.6 (0.1–27.4) | >0.9 |
| Steroids, % (n) | 11 (15) | 10 (12) | 30 (3) | 0.3 (0.1–1.7) | 0.2 |
a
Exact logistic regression used to calculate Odds Ratios (OR) and 95% Confidence Intervals (CI).
b
P-values reported for continuous variables were results of an independent two-sample t-test and were associated with the OR for categorical variables.
c
Five adult meningitis cases were missing age.
d
Excludes suspected meningitis cases.
e
Restricted to patients with imaging.