Using the largest review of historical anthrax cases yet compiled, researchers from Weill Cornell Medicine and the U.S. government have created a checklist to identify patients who develop a common and potentially fatal secondary meningitis infection. This tool fills a known gap in managing patients during a large-scale outbreak such as a bioterror attack, in which traditional diagnosis using lumbar puncture and imaging may be impossible on a mass scale.
In such a public health emergency, officials would need to triage patients to properly allocate medical and other resources to maximize patient survival. Anthrax patients with meningitis, an infection of the lining of the brain and nervous system, would be among those needing the most urgent and complex treatment.
"Our paper provides public health officials both in the United States and around the world with a very straightforward rule that could be implemented to both improve patient care and also improve the management of what assuredly would be very scarce resources," said senior author Dr. Nathaniel Hupert, an associate professor in the Department of Healthcare Policy and Research and the Joan and Sanford I. Weill Department of Medicine.
In the paper, published May 30 in Clinical Infectious Diseases, researchers based at the U.S. Centers for Disease and Control and Prevention, Weill Cornell Medicine and Stanford Medicine examined 363 cases of anthrax meningitis spanning from 1880 to 2013. The scientists pinpointed four key symptoms that raised the likelihood of anthrax meningitis: severe headache; altered mental status; classic physical signs of meningitis; and other neurological signs, such as confusion, imbalance and neck stiffness.
Using the tool could help doctors identify up to 89 percent of adult patients who were likely to have anthrax meningitis, even without laboratory tests or imaging; patients with more than one of the items on the checklist were 98 percent likely to have the condition. With 61 pediatric patients in the case series, the authors found similarly high accuracy for the tool among children.
"Our work shows that it's possible to create straightforward checklists that can be used with great effect in emergency situations," Dr. Hupert said. "A larger goal of our work at Weill Cornell Medicine and the Cornell Institute for Disease and Disaster Preparedness is to make sure that patient safety and healthcare quality don't fall by the wayside during small and large-scale disasters. I think this paper is a clear step in that direction."