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To the Editor.—
The extensive and informative article about bioterrorism published in the April 2002 issue of Pediatrics1 has some gaps in information that I feel are important to mention.
The authors suggest that a sputum sample should be sent when suspecting inhalational anthrax. However, anthrax does not cause a truly pneumonic process. When the spores of this organism reach the alveolar space, they are phagocyted by macrophages and transported to the lymphatic system, causing a mediastinal adenitis. Given this fact, the yield of a diagnostic Gram stain or a positive culture from a sputum sample is very low.2 None of the cases of bioterrorism-related inhalational anthrax reported after September 11, 2001, have had a positive sputum culture.
Although the authors describe the clinical manifestations of gastrointestinal anthrax, they fail to mention that nausea and vomiting are a prominent (and misleading) finding …
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