Recognition and Treatment of Anthrax

To the Editor: The Consensus Statement on anthrax as a biological weapon by Dr Inglesby and colleagues¹ included much useful information, but the treatment section mentioned only antibiotics. In contrast, a clinical report² of 1 of the few patients to survive intestinal anthrax contains important information about other aspects of effective management. This patient, who had purulent ascitic fluid, appeared to present with an acute abdomen, and had unnecessary surgery as a result. A gram-positive rod in the blood cultures was initially called a contaminant by the laboratory. The patient's course was complicated by pneumonitis, gastrointestinal hemorrhage with melena (probably from the site of primary intestinal infection), and focal cerebritis or meningitis. Prolonged antibiotic therapy was necessary to treat his disseminated infection, but he probably would not have survived without meticulous attention to water and electrolyte balance, prompt replacement of blood losses, and achievement of hemostasis.