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The mail-related dispersal of Bacillus anthracis spores in the Washington, D.C., area during October 2001 resulted in 5 confirmed cases of inhalational anthrax. We identified an additional 144 ill persons who were potentially exposed to aerosolized spores and whose symptoms were compatible with early inhalational anthrax but whose clinical course and nonserologic laboratory evaluation revealed no evidence for B. anthracis infection. We hypothesized that early antibiotic use could have decreased the sensitivity of diagnostic tests or that bioterrorism-related inhalational anthrax may include mild disease.

clinical infectious diseases/clinical infectious diseases (online. university of chicago. press)

No Evidence of a Mild Form of Inhalational Bacillus anthracis Infection During a Bioterrorism-Related Inhalational Anthrax Outbreak in Washington, D.C., in 2001