Index Case of Fatal Inhalational Anthrax Due to Bioterrorism in the United States

This case report provides a description of the first case of fatal inhalational anthrax in the United States in 25 years. This 63-year-old newspaper photo editor had a rapidly progressive febrile illness, and lumbar puncture showed cloudy cerebrospinal fluid with numerous polymorphonuclear leukocytes and many large gram-positive bacilli, singly and in chains. A diagnosis of inhalational anthrax was made, and despite aggressive treatment the patient died soon thereafter. The infection appeared to have been transmitted through mail contaminated with anthrax spores as a result of biologic terrorism. This report describes the first case of fatal inhalational anthrax in the United States in 25 years. Since the mid-1990s, Bacillus anthracis, the causative agent of anthrax, has been postulated to be a likely agent of biological warfare or terrorism because of its physical properties and its virulence factors. Several countries have been known to have biologic-weapons programs that were focusing on B. anthracis for potential military use. However, fatal anthrax had not been encountered in the United States as a weapon in an act of war or terror until the index case we report was recognized 1 . Anthrax is a rare bacterial infection acquired by inhalation, ingestion, or cutaneous contact with the endospores of B. anthracis . . .