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Novel Checklist Can Distinguish Anthrax Exposure From Other Illnesses

TUESDAY, March 19, 2019 -- A newly developed checklist can rapidly identify anthrax cases after a suspected mass exposure, according to a study published online March 19 in the Annals of Internal Medicine.

Nathaniel Hupert, M.D., M.P.H., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues used data from 408 previous cases of patients with inhalation, ingestion, and cutaneous anthrax and primary anthrax meningitis (plus 657 controls) to develop a checklist that rapidly distinguishes anthrax from nonanthrax illnesses and identifies patients requiring diagnostic testing after a population exposure.

The researchers found that checklist-directed triage without diagnostic testing correctly classified 95 percent of 353 adult anthrax case patients and 76 percent of control patients (positive likelihood ratio [LR], 3.96; negative LR, 0.07; false-negative rate, 5 percent; false-positive rate, 24 percent). Diagnostic testing improved overall test characteristics (positive LR, 8.9; negative LR, 0.06; false-negative rate, 5 percent; false-positive rate, 11 percent) and was needed for triage in up to 5 percent of case patients and 15 percent of control patients. Inclusion of pediatric patients only minimally affected checklist sensitivity and specificity.

"A brief checklist covering symptoms and signs can distinguish anthrax from other conditions with minimal need for diagnostic testing after known or suspected population exposure," the authors write.

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Posted: March 2019

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