Table 2.
Demographics and Clinical Findings on Presentation Associated With Overall Mortality Among Adults Hospitalized for Cutaneous Anthrax, 1950–2018
| Total | Died | Survived | ||||||
|---|---|---|---|---|---|---|---|---|
| Characteristic | n (%) | n (%) | n (%) | Odds Ratio (95% Confidence Interval) | P Value | |||
| Overall | 182 (100) | 47 (25.8) | 135 (74.2) | |||||
| Demographics | ||||||||
| Age, years | ||||||||
| 18–45 | 108 (60.3) | 179 | 19 (40.4) | 47 | 89 (67.4) | 132 | Reference | - |
| 46–64 | 64 (35.8) | 179 | 24 (51.1) | 47 | 40 (30.3) | 132 | 2.8 (1.3–6.1) | <.01 |
| 65+ | 7 (3.9) | 179 | 4 (8.5) | 47 | 3 (2.3) | 132 | 6.1 (1.0–45.2) | .06 |
| Sex | ||||||||
| Male | 132 (72.9) | 181 | 38 (80.9) | 47 | 94 (70.1) | 134 | 1.8 (.8–4.6) | .2 |
| Female | 49 (27.1) | 181 | 9 (19.1) | 47 | 40 (29.9) | 134 | Reference | - |
| Pregnant | 5 (10.2) | 49 | 2 (22.2) | 9 | 3 (7.5) | 40 | 3.4 (.2–36.0) | .4 |
| Not pregnant | 44 (89.8) | 49 | 7 (77.8) | 9 | 37 (92.5) | 40 | Reference | - |
| Geographic location1 | ||||||||
| European Region | 85 (46.7) | 182 | 11 (23.4) | 47 | 74 (54.8) | 135 | Reference | - |
| Eastern Mediterranean Region | 27 (14.8) | 182 | 4 (8.5) | 47 | 23 (17.0) | 135 | 1.2 (.2–4.4) | 1.0 |
| Region of the Americas | 22 (12.1) | 182 | 6 (12.8) | 47 | 16 (11.9) | 135 | 2.5 (.7–8.8) | .2 |
| Western Pacific Region | 9 (4.9) | 182 | 3 (6.4) | 47 | 6 (4.4) | 135 | 3.3 (.5–18.5) | .3 |
| South-East Asia Region | 27 (14.8) | 182 | 15 (31.9) | 47 | 12 (7.8) | 135 | 8.2 (2.8–25.4) | <.0001 |
| African Region | 12 (7.0) | 182 | 8 (17.0) | 47 | 4 (3.0) | 135 | 12.9 (2.9–68.9) | <.001 |
| Clinical findings | ||||||||
| Symptoms | ||||||||
| Fever or chills | 87 (48.6) | 179 | 34 (73.9) | 46 | 53 (39.8) | 133 | 4.2 (1.9–9.9) | .0001 |
| Anxiety | 5 (2.8) | 180 | 4 (8.7) | 46 | 1 (0.7) | 134 | 12.5 (1.2–628.3) | .03 |
| Headache | 11 (6.1) | 179 | 9 (19.1) | 47 | 2 (1.5) | 132 | 15.1 (3.0–149.5) | <.001 |
| Severe headache | 2 (1.1) | 181 | 2 (4.3) | 47 | 0 (0) | 134 | 7.0 (.8–∞) | .07 |
| Abdominal pain | 2 (1.1) | 182 | 2 (4.3) | 47 | 0 (0) | 135 | 7.1 (.8–∞) | .07 |
| Vomiting, emesis, nausea | 10 (18) | 180 | 10 (21.3) | 47 | 0 (0) | 133 | 48.3 (9.3–∞) | <.001 |
| Vital signs | ||||||||
| Fever (>38°C) | 31 (54.4) | 57 | 11 (73.3) | 15 | 20 (47.6) | 42 | 3.0 (.7–14.9) | .2 |
| Tachycardia (>90 bpm) | 14 (58.3) | 24 | 6 (66.7) | 9 | 8 (53.3) | 15 | 1.7 (.2–14.7) | .8 |
| Systolic hypotension (<90 mm Hg) | 6 (33.3) | 18 | 4 (57.1) | 7 | 2 (18.2) | 11 | 5.3 (.5–90.1) | .2 |
| Diastolic hypotension (<60 mm Hg) | 6 (35.3) | 17 | 5 (71.4) | 7 | 1 (10.0) | 10 | 17.3 (1.2–∞) | .04 |
| Skin | ||||||||
| Lymphadenopathy | 33 (18.2) | 181 | 12 (25.5) | 47 | 21 (15.7) | 134 | 1.8 (.8–4.4) | .2 |
| Lesion characteristics | ||||||||
| Eschar number | ||||||||
| 1 | 142 (82.6) | 172 | 32 (80.0) | 40 | 110 (83.3) | 132 | Reference | - |
| 2+ | 30 (17.4) | 172 | 8 (20.0) | 40 | 22 (16.7) | 132 | 1.2 (.4–3.3) | .8 |
| Head or neck lesion | 63 (34.6) | 172 | 11 (27.5) | 40 | 52 (39.4) | 132 | 0.6 (.3–1.4) | .3 |
| Head or neck edema | 57 (31.7) | 180 | 10 (21.7) | 46 | 47 (35.1) | 134 | 0.6 (.2–1.2) | .2 |
| On or crossing a joint | 79 (45.9) | 172 | 20 (50.0) | 40 | 59 (44.7) | 132 | 1.2 (.6–2.7) | .7 |
| Skin trauma | 15 (8.2) | 182 | 7 (14.9) | 47 | 8 (5.9) | 135 | 3.7 (1.1–12.9) | .03 |
| Thoracic edema | 19 (10.4) | 182 | 10 (21.3) | 47 | 9 (6.7) | 135 | 3.8 (1.3–11.3) | .02 |
| Malignant pustule edema | 28 (16.5) | 170 | 12 (32.4) | 37 | 16 (12.0) | 133 | 3.5 (1.3–9.0) | .01 |
| Neurologic | ||||||||
| Nonheadache, nonmeningeal signs | 23 (12.6) | 182 | 22 (46.8) | 47 | 1 (0.7) | 135 | 113.8 (16.9–∞) | <.0001 |
| Other | ||||||||
| Evidence of coagulopathy | 5 (2.7) | 182 | 4 (8.5) | 47 | 1 (0.7) | 135 | 13.5 (1.3–681.7) | .03 |
| Diagnostic test results | ||||||||
| Leukocytosis (>12 × 103/μL) | 42 (23.1) | 87 | 6 (60.0) | 10 | 36 (46.8) | 77 | 1.7 (.4–8.9) | .7 |
| Thrombocytopenia (<130 × 103/mm3) | 2 (1.1) | 7 | 1 (50.0) | 2 | 1 (20.0) | 5 | 3.2 (–391.0) | 1.0 |
| Hemoconcentration | 6 (3.3) | 25 | 1 (14.3) | 7 | 5 (27.8) | 18 | 0.4 (–5.5) | .9 |
| Complications | ||||||||
| Bacteremia | ||||||||
| At presentation | 2 (1.1) | 182 | 1 (2.1) | 47 | 1 (0.7) | 135 | 2.9 (.1–230.3) | .9 |
| Throughout hospitalization | 15 (8.2) | 182 | 14 (29.8) | 47 | 1 (0.7) | 135 | 55.4 (7.9–∞) | <.000 |
n = 182.
a
Geographic locations of countries based on the World Health Organization classification system.
b
Skin trauma is defined as the presence of insect or other bites, lacerations, or other open wounds.
c
Cases demonstrating symptoms of shock or treatment with vasopressors excluded (n = 10).
d
Nonheadache, nonmeningeal signs include seizure, cranial nerve signs, limb weakness, and papilledema.
e
Hemoconcentration defined by sex-specific elevations in hemoglobin (male, 14.0–18.0 g/dL; female, 11.5–15.5 g/dL) or hematocrit (male, 39%–49%; female, 33%–43%) values.