Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
Clinical Characteristics and Survival of Hospitalized Anthrax Patients with Pleural, Pericardial, or Peritoneal Fluid Collections.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Holty Jon-Erik C, Person Marissa K, Binney Sophie, Cook Rachel, Mongkolrattanothai Thitipong, Kirpich Alexander, Schrodt Caroline A, Bower William A, Hendricks Katherine
Аннотация
BACKGROUND: The prevalence of pleural, pericardial, or peritoneal effusions among anthrax patients is unknown, as is the impact of drainage on mortality.
METHODS: We identified hospitalized anthrax patients with effusions published 1920-2018 worldwide (N = 1108), excluding cases with insufficient clinical data. Two manuscript authors independently abstracted fluid collection and morbidity data. We evaluated how effusion drainage impacted mortality using logistic regressions.
RESULTS: Effusions were present in 99 (13%) of 744 eligible anthrax patients; 65 (66%) of these died. Pleural effusions developed in 72% of patients with inhalation anthrax (N = 61), most often bilaterally. Similarly, 55% of ingestion anthrax patients (N = 55) developed peritoneal effusions. Pericardial effusions were rare (1.7%). Most pleural Gram stains or cultures obtained pre-antimicrobials were positive (83%). Of the 44 patients with clinically significant pleural effusions, only 59% received drainage. Drainage of these effusions was associated with survival (odds ratio [OR] 38.3, 95% confidence interval [CI]: 4.3-339.0), even when controlling for antimicrobials and/or antiserum. Most patients with fatal outcomes following drainage had either bilateral effusions with single-sided drainage or effusion recurrence. Although drainage of clinically significant peritoneal effusions was not associated with survival, laparotomy ± resection for peritonitis was associated (OR 53.6, 95% CI: 9.4-inf).
CONCLUSIONS: Pleural drainage appears associated with survival. Most inhalation anthrax patients develop bilateral collections, and may require chest-tube insertions. Surgical source control is associated with survival for anthrax-associated peritonitis. Following a wide-area release of Bacillus anthracis, public health authorities should anticipate many patients may require source control (eg, chest tube drainage or surgery) and plan accordingly.
METHODS: We identified hospitalized anthrax patients with effusions published 1920-2018 worldwide (N = 1108), excluding cases with insufficient clinical data. Two manuscript authors independently abstracted fluid collection and morbidity data. We evaluated how effusion drainage impacted mortality using logistic regressions.
RESULTS: Effusions were present in 99 (13%) of 744 eligible anthrax patients; 65 (66%) of these died. Pleural effusions developed in 72% of patients with inhalation anthrax (N = 61), most often bilaterally. Similarly, 55% of ingestion anthrax patients (N = 55) developed peritoneal effusions. Pericardial effusions were rare (1.7%). Most pleural Gram stains or cultures obtained pre-antimicrobials were positive (83%). Of the 44 patients with clinically significant pleural effusions, only 59% received drainage. Drainage of these effusions was associated with survival (odds ratio [OR] 38.3, 95% confidence interval [CI]: 4.3-339.0), even when controlling for antimicrobials and/or antiserum. Most patients with fatal outcomes following drainage had either bilateral effusions with single-sided drainage or effusion recurrence. Although drainage of clinically significant peritoneal effusions was not associated with survival, laparotomy ± resection for peritonitis was associated (OR 53.6, 95% CI: 9.4-inf).
CONCLUSIONS: Pleural drainage appears associated with survival. Most inhalation anthrax patients develop bilateral collections, and may require chest-tube insertions. Surgical source control is associated with survival for anthrax-associated peritonitis. Following a wide-area release of Bacillus anthracis, public health authorities should anticipate many patients may require source control (eg, chest tube drainage or surgery) and plan accordingly.