RT Journal
A1 Nalin DR
T1 REcognition and treatment of anthrax
JF JAMA
JO JAMA
YR 1999
FD November 3
VO 282
IS 17
SP 1624
OP 1625
DO 10-1001/pubs.JAMA-ISSN-0098-7484-282-17-jbk1103
UL http://dx.doi.org/10-1001/pubs.JAMA-ISSN-0098-7484-282-17-jbk1103
AB 
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.