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Full Title: Pediatric Anthrax: Implications for Bioterrorism Preparedness
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Objectives: To systematically review the literature about children with anthrax to describe their
clinical course, treatment responses, and the predictors of disease progression and mortality.
Data Sources: MEDLINE® (1966-2005), 14 selected journal indexes (1900-1966) and
bibliographies of all retrieved articles.
Review Methods: We sought case reports of pediatric anthrax published between 1900 and 2005
meeting predefined criteria. We abstracted three types of data from the English-language
- Patient information (e.g., age, gender, nationality).
- Symptom and disease progression information (e.g., whether the patient developed meningitis).
- Treatment information (e.g., treatments received, year of treatment).
We compared the clinical symptoms
and disease progression variables for the pediatric cases with data on adult anthrax cases
Results: We identified 246 titles of potentially relevant articles from our MEDLINE® search and
2253 additional references from our manual search of the bibliographies of retrieved articles and
the indexes of the 14 selected journals. We included 62 case reports of pediatric anthrax
including two inhalational cases, 20 gastrointestinal cases, 37 cutaneous cases, and three atypical
Anthrax is a relatively common and historically well-recognized disease and yet rarely
reported among children, suggesting the possibility of significant under-diagnosis, underreporting,
and/or publication bias. Children with anthrax present with a wide range of clinical
signs and symptoms, which differ somewhat from the presenting features of adults with anthrax.
Like adults, children with gastrointestinal anthrax have two distinct clinical presentations:
- Upper tract disease characterized by dysphagia and oropharyngeal findings.
- Lower tract disease characterized by fever, abdominal pain, and nausea and vomiting.
Additionally, children with
inhalational disease may have "atypical" presentations including primary meningoencephalitis.
Children with inhalational anthrax have abnormal chest roentgenograms; however, children with
other forms of anthrax usually have normal roentgenograms. Nineteen of the 30 children (63%)
who received penicillin-based antibiotics survived; whereas nine of 11 children (82%) who
received anthrax antiserum survived.
Conclusions: There is a broad spectrum of clinical signs and symptoms associated with
pediatric anthrax. The limited data available regarding disease progression and treatment
responses for children infected with anthrax suggest some differences from adult populations.
Preparedness planning efforts should specifically address the needs of pediatric victims.
Pediatric Anthrax: Implications for Bioterrorism Preparedness
Evidence-based Practice Center: University of California, San Francisco (UCSF)-Stanford
Topic Nominator: Health Resources and Services Administration (HRSA)
Current as of August 2006