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Evaluation of Inhalational Anthrax

Robert S. Porter, MD
JAMA. 2002;287(8):984-985. doi:10.1001/jama.287.8.983.
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To the Editor: Dr Borio and colleagues1 described 2 patients who died of inhalation anthrax. Some factors in the first patient's case, however, raise concern that there was an initial gastrointestinal anthrax infection in addition to the inhalational illness, which became apparent later. The patient's prodrome consisted of nausea, vomiting, and abdominal pain, diagnosed by the patient himself as food poisoning. He did not complain of chest or respiratory symptoms on his first visit, and the symptom constellation prompted the initial treating physician to diagnose gastroenteritis. The postmortem examination confirmed a focal infection of the ileum, although mesenteric nodes were apparently unaffected.

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