Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880.

TitleIdentifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880.
Publication TypeJournal Article
Year of Publication2016
AuthorsKatharios-Lanwermeyer S, Holty J-E, Person M, Sejvar J, Haberling D, Tubbs H, Meaney-Delman D, Pillai SK, Hupert N, Bower WA, Hendricks K
JournalClin Infect Dis
Date Published2016 06 15
KeywordsAdolescent, Adult, Anthrax, Bacillus anthracis, Bioterrorism, Child, Child, Preschool, Cognitive Dysfunction, Female, Headache, Humans, Male, Mass Casualty Incidents, Meningitis, Bacterial, Middle Aged

BACKGROUND: Bacillus anthracis, the causative agent of anthrax, is a potential bioterrorism agent. Anthrax meningitis is a common manifestation of B. anthracis infection, has high mortality, and requires more aggressive treatment than anthrax without meningitis. Its rapid identification and treatment are essential for successful management of an anthrax mass casualty incident.

METHODS: Three hundred six published reports from 1880 through 2013 met predefined inclusion criteria. We calculated descriptive statistics for abstracted cases and conducted multivariable regression on separate derivation and validation cohorts to identify clinical diagnostic and prognostic factors for anthrax meningitis.

RESULTS: One hundred thirty-two of 363 (36%) cases with systemic anthrax met anthrax meningitis criteria. Severe headache, altered mental status, meningeal signs, and other neurological signs at presentation independently predicted meningitis in the derivation cohort and were tested as a 4-item assessment tool for use during anthrax mass casualty incidents. Presence of any 1 factor on admission had a sensitivity for finding anthrax meningitis of 89% (83%) in the adult (pediatric) validation cohorts. Anthrax meningitis was unlikely in the absence of any of these signs or symptoms (likelihood ratio [LR]- = 0.12 [0.19] for adult [pediatric] cohorts), while presence of 2 or more made meningitis very likely (LR+ = 26.5 [30.0]). Survival of anthrax meningitis was predicted by treatment with a bactericidal agent (P = .005) and use of multiple antimicrobials (P = .01).

CONCLUSIONS: We developed an evidence-based assessment tool for screening patients for meningitis during an anthrax mass casualty incident. Its use could improve both patient outcomes and resource allocation in such an event.

Alternate JournalClin. Infect. Dis.
PubMed ID27025833
PubMed Central IDPMC5034857
Grant ListCC999999 / / Intramural CDC HHS / United States
Faculty Publication