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Ann Fam Med. 2004 Sep-Oct;2(5):438-44.

The primary care differential diagnosis of inhalational anthrax.

Author information

  • 1Department of Family Medicine, University of Wisconsin Medical School, Madison, Wis 53715, USA. jtemte@wingra.fammed.wisc.edu

Abstract

PURPOSE:

Inhalational anthrax is an extremely rare infectious disease with nonspecific initial symptoms, thus making diagnosis on clinical grounds difficult. After a covert release of anthrax spores, primary care physicians will be among the first to evaluate cases. This study defines the primary care differential diagnosis of inhalational anthrax.

METHODS:

In May 2002, we mailed survey instruments consisting of 3 randomly chosen case vignettes describing patients with inhalational anthrax to a nationwide random sample of 665 family physicians. Nonrespondents received additional mailings. Physicians were asked to provide their most likely nonanthrax diagnosis for each case.

RESULTS:

The response rate was 36.9%. Diagnoses for inhalational anthrax were grouped into 35 diagnostic categories, with pneumonia (42%), influenza (10%), viral syndrome (9%), septicemia (8%), bronchitis (7%), central nervous system infection (6%), and gastroenteritis (4%) accounting for 86% of all diagnoses. Diagnoses differed significantly between cases that proved to be fatal and those that proved to be nonfatal.

CONCLUSIONS:

Inhalational anthrax resembles common diagnoses in primary care. Surveillance systems for early detection of bioterrorism events that rely only on diagnostic codes will be hampered by false-positive alerts. Consequently, educating frontline physicians to recognize and respond to bioterrorism is of the highest priority.

PMID:
15506578
[PubMed - indexed for MEDLINE]
PMCID:
PMC1466714
Free PMC Article

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