Table 3.
Demographics and Clinical Findings on Presentation Associated With Meningitis Among Adults Hospitalized for Cutaneous Anthrax, 1950–2018
| Total | Meningitis | No Meningitis | ||||||
|---|---|---|---|---|---|---|---|---|
| Characteristic | n (%) | n (%) | n (%) | Odds Ratio (95% Confidence Interval) | P Value | |||
| Overall | 182 (100) | 36 (19.8) | 146 (80.2) | |||||
| Demographics | ||||||||
| Age, years | ||||||||
| 18–45 | 108 (60.3) | 179 | 14 (38.9) | 36 | 94 (65.7) | 143 | Reference | |
| 46–64 | 64 (35.8) | 179 | 21 (58.3) | 36 | 43 (30.1) | 143 | 3.3 (1.4–7.6) | <.01 |
| 65+ | 7 (3.9) | 179 | 1 (2.8) | 36 | 6 (4.2) | 143 | 1.1 (0–10.4) | 1.0 |
| Sex | ||||||||
| Male | 132 (72.9) | 181 | 29 (80.6) | 36 | 103 (71.0) | 145 | 1.7 (.7–4.9) | .3 |
| Female | 49 (27.1) | 181 | 7 (19.4) | 36 | 42 (29.0) | 145 | Reference | |
| Pregnant | 5 (10.2) | 49 | 2 (28.6) | 7 | 3 (7.1) | 42 | 4.9 (.3–55.9) | .3 |
| Not pregnant | 44 (89.8) | 49 | 5 (71.4) | 7 | 39 (92.9) | 42 | Reference | |
| Geographic locationa | ||||||||
| European Region | 85 (46.7) | 182 | 9 (19.4) | 36 | 76 (52.1) | 146 | Reference | |
| Eastern Mediterranean Region | 27 (14.8) | 182 | 3 (8.3) | 36 | 24 (16.4) | 146 | 1.1 (.2–4.7) | 1.0 |
| Region of the Americas | 22 (12.1) | 182 | 2 (5.6) | 36 | 20 (13.7) | 146 | 0.8 (.1–4.6) | 1.0 |
| Western Pacific Region | 9 (4.9) | 182 | 3 (8.3) | 36 | 6 (4.1) | 146 | 4.1 (.6–23.9) | .2 |
| South-East Asia Region | 27 (14.8) | 182 | 13 (36.1) | 36 | 14 (9.6) | 146 | 7.6 (3.5–24.8) | <.001 |
| African Region | 12 (6.6) | 182 | 6 (16.7) | 36 | 6 (4.1) | 146 | 8.1 (1.8–38.5) | <.01 |
| Clinical findings | ||||||||
| Symptoms | ||||||||
| Fever or chills | 87 (48.6) | 179 | 26 (74.3) | 35 | 61 (42.4) | 144 | 3.9 (1.6–10.2) | .001 |
| Anxiety | 5 (2.8) | 180 | 2 (5.7) | 35 | 3 (2.1) | 145 | 2.8 (.2–25.9) | .5 |
| Headache | 11 (6.1) | 179 | 9 (19.4) | 36 | 2 (1.4) | 143 | 22.9 (4.4–229.0) | <.0001 |
| Severe headache | 2 (1.1) | 181 | 2 (5.6) | 36 | 0 (0) | 145 | 10.0 (1.2–∞) | .04 |
| Abdominal pain | 2 (1.1) | 182 | 2 (5.6) | 36 | 0 (0) | 146 | 10.0 (1.2–∞) | .04 |
| Vomiting, emesis, nausea | 10 (18) | 180 | 10 (27.8) | 36 | 0 (0) | 144 | 73.4 (14.6–∞) | <.0001 |
| Vital signs | ||||||||
| Fever (>38°C) | 31 (54.4) | 57 | 9 (75.0) | 12 | 22 (48.9) | 45 | 3.1 (.7–20.0) | .2 |
| Tachycardia (>90 bpm) | 14 (7.7) | 24 | 6 (75.0) | 8 | 8 (50.0) | 16 | 2.9 (.4–37.6) | .5 |
| Systolic hypotension (<90 mm Hg) | 6 (3.3) | 18 | 3 (50.0) | 6 | 3 (25.0) | 12 | 2.8 (.2–36.4) | .6 |
| Diastolic hypotension (<60 mm Hg) | 6 (3.3) | 17 | 4 (66.7) | 6 | 2 (18.2) | 11 | 7.6 (.6–151.7) | .1 |
| Skin | ||||||||
| Lymphadenopathy | 33 (18.2) | 181 | 12 (33.3) | 36 | 21 (14.5) | 145 | 2.9 (1.2–7.3) | .02 |
| Lesion characteristics | ||||||||
| Eschar number | ||||||||
| 1 | 141 (82.0) | 172 | 29 (67.7) | 31 | 136 (96.5) | 141 | Reference | |
| 2+ | 31 (18.0) | 172 | 2 (6.5) | 31 | 5 (3.5) | 141 | 1.2 (.3–3.4) | .9 |
| Head or neck lesion | 63 (36.0) | 172 | 8 (25.8) | 31 | 55 (39.0) | 141 | 0.6 (.2–1.4) | .2 |
| Head or neck edema | 57 (31.7) | 180 | 7 (20.0) | 35 | 50 (34.5) | 145 | 0.5 (.2–1.2) | .1 |
| On or crossing a joint | 79 (45.9) | 172 | 17 (54.8) | 31 | 62 (44.0) | 141 | 1.5 (.7–3.7) | .4 |
| Skin traumab | 15 (8.2) | 182 | 6 (16.7) | 36 | 9 (6.2) | 146 | 3.0 (.8–10.4) | .1 |
| Thoracic edema | 19 (10.4) | 182 | 8 (22.2) | 36 | 11 (7.5) | 146 | 3.5 (1.1–10.5) | .03 |
| Malignant pustule edemac | 28 (16.5) | 170 | 12 (41.4) | 29 | 16 (11.3) | 141 | 5.4 (2.0–14.8) | <.001 |
| Neurologic | ||||||||
| Nonheadache, nonmeningeal signsd | 23 (12.6) | 182 | 23 (63.9) | 36 | 0 (0) | 146 | 333.0 (68.4–∞) | <.0001 |
| Other | ||||||||
| Evidence of coagulopathies | 5 (2.8) | 178 | 4 (12.5) | 32 | 1 (0.7) | 146 | 20.2 (1.9–∞) | <.01 |
| Diagnostic test results | ||||||||
| Leukocytosis (>12 × 103/μL) | 42 (48.3) | 87 | 6 (75.0) | 8 | 36 (45.6) | 79 | 3.5 (.6–37.9) | .2 |
| Thrombocytopenia (<130 × 103/mm3) | 2 (28.6) | 7 | 1 (50.0) | 2 | 1 (20.0) | 5 | 3.2 (–391.0) | 1.0 |
| Hemoconcentratione | 6 (24.0) | 25 | 1 (20.0) | 5 | 5 (25.0) | 20 | 0.4 (–5.5) | .9 |
| Complications | ||||||||
| Bacteremia | ||||||||
| At presentation | 2 (1.1) | 182 | 1 (2.8) | 36 | 1 (0.7) | 146 | 4.1 (.1–327.4) | .7 |
| Throughout hospitalization | 15 (8.2) | 182 | 12 (33.3) | 36 | 3 (2.1) | 146 | 23.2 (5.7–137.2) | <.0001 |
| Outcomes | ||||||||
| Fatal | 47 (25.8) | 182 | 35 (97.2) | 36 | 12 (8.2) | 146 | 363.5 (52.7–∞) | <.0001 |
n = 182.
a
Geographic regions of countries based on 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, 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.