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Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880.
Clin Infect Dis. 2016 06 15; 62(12):1537-1545.CI

Abstract

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.

Authors+Show Affiliations

Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.Pulmonary, Critical Care and Sleep Medicine Section, VA Palo Alto Healthcare System Department of Medicine, Stanford University, California.Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.Division of Preparedness and Emerging Infections.National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Division of Preparedness and Emerging Infections.Departments of Healthcare Policy and Research and of Medicine, Weill Medical College, Cornell University, New York Presbyterian Hospital, New York.Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

27025833

Citation

Katharios-Lanwermeyer, Stefan, et al. "Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 62, no. 12, 2016, pp. 1537-1545.
Katharios-Lanwermeyer S, Holty JE, Person M, et al. Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880. Clin Infect Dis. 2016;62(12):1537-1545.
Katharios-Lanwermeyer, S., Holty, J. E., Person, M., Sejvar, J., Haberling, D., Tubbs, H., Meaney-Delman, D., Pillai, S. K., Hupert, N., Bower, W. A., & Hendricks, K. (2016). Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 62(12), 1537-1545. https://doi.org/10.1093/cid/ciw184
Katharios-Lanwermeyer S, et al. Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880. Clin Infect Dis. 2016 06 15;62(12):1537-1545. PubMed PMID: 27025833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880. AU - Katharios-Lanwermeyer,Stefan, AU - Holty,Jon-Erik, AU - Person,Marissa, AU - Sejvar,James, AU - Haberling,Dana, AU - Tubbs,Heather, AU - Meaney-Delman,Dana, AU - Pillai,Satish K, AU - Hupert,Nathaniel, AU - Bower,William A, AU - Hendricks,Katherine, Y1 - 2016/03/29/ PY - 2015/11/04/received PY - 2016/03/17/accepted PY - 2016/3/31/entrez PY - 2016/3/31/pubmed PY - 2017/10/20/medline KW - Bacillus anthracis KW - anthrax KW - mass casualty incident KW - meningitis KW - resource allocation SP - 1537 EP - 1545 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 62 IS - 12 N2 - 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. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/27025833/full_citation L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw184 DB - PRIME DP - Unbound Medicine ER -