HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Supplemental data: Appendix In Brief TRACK Comments: Submit a response TRACK Comments: View responses Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Temte, J. L. Articles by Zinkel, A. R. Search for Related Content PubMed PubMed Citation Articles by Temte, J. L. Articles by Zinkel, A. R.

The Primary Care Differential Diagnosis of Inhalational Anthrax

Department of Family Medicine, University of Wisconsin Medical School, Madison, Wis

CORRESPONDING AUTHOR: Jonathan L. Temte, MD, PhD University of Wisconsin, Department of Family Medicine, 777 S Mills St, Madison, WI 53715, jtemte{at}wingra.fammed.wisc.edu

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 front-line physicians to recognize and respond to bioterrorism is of the highest priority.

Key Words: Bioterrorism • primary health care • anthrax • surveillance • diagnosis, differential

This article has been cited by other articles:

				K. C. Stange In this Issue: The Patient-Clinician Relationship and Practice-Based Network Research Ann. Fam. Med, September 1, 2004; 2(5): 386 - 387. [Full Text] [PDF]

				J. L. Temte and A. L. Anderson Rapid Assessment of Agents of Biological Terrorism: Defining the Differential Diagnosis of Inhalational Anthrax Using Electronic Communication in a Practice-Based Research Network Ann. Fam. Med, September 1, 2004; 2(5): 434 - 437. [Abstract] [Full Text] [PDF]

TRACK Comments: