Screening
Screening tools for diagnosis of anthrax
There is no rapid screening test for infection due to anthrax. A nasal swab for culture can be performed to define an area of anthrax exposure in the event of spore aerosolisation. However, current recommendations suggest that these cultures are for epidemiological purposes only; nasal swabs should not be used to diagnosis anthrax, to replace environmental sampling, or to determine the need for antimicrobial prophylaxis.[37]
Screening tools for diagnosis of anthrax meningitis
In the setting of a mass casualty event, conventional standards for diagnosis of meningitis (e.g., lumbar puncture, imaging) might be limited or unavailable. Therefore, a screening tool has been developed to identify patients with anthrax meningitis for these situations.
Patients are likely to have anthrax meningitis if they meet either of the following criteria.[1]
≥2 of the following signs or symptoms: severe headache, altered mental status, meningeal signs, or other neurological deficits; or
≥1 of the following signs or symptoms: severe headache, altered mental status, meningeal signs, or other neurological deficits; AND ≥1 of the following signs or symptoms: nausea/vomiting, abdominal pain, or fever (either subjective or measured) or chills.
Patients are unlikely to have meningitis if they do not have severe headache, altered mental status, meningeal signs, and other neurological deficits. This screening tool had a sensitivity of 86% and a specificity of 92%, with 2.5% of adults requiring further testing.
Patients who have sepsis, obesity, hypertension, COPD, and current/former smokers appear to be at increased risk for meningitis.
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