New study sheds light on anthrax vs. flu

Do you know how to tell a case of ordinary flu from inhalational anthrax? Failing to do so can have potentially devastating consequences for your ED. A new study from Weill Medical College of Cornell University in New York City identifies key symptoms to help you distinguish inhalational anthrax from the flu and other common respiratory conditions.1

Your ED should develop screening protocols to improve rapid identification of patients with possible inhalational anthrax in the event of a bioterrorism attack, recommends Nathaniel Hupert, MD, MPH, assistant professor of public health and medicine at the facility and the study’s lead investigator.

The researchers studied 28 cases of inhalational anthrax from 1920-2001 and 4,694 cases of viral respiratory tract illnesses. Here are key findings:

  • Fever and cough were common in both groups.
  • Neurological symptoms including mental confusion, loss of consciousness and dizziness, gastrointestinal symptoms such as nausea and vomiting, and shortness of breath were much more common in patients with inhaled anthrax.
  • Although sore throat and runny nose were present in some anthrax-infected patients, these symptoms never occurred without at least one of the other symptoms.

During the 2001 anthrax attacks, EDs lacked clear-cut criteria and screening protocols, says Hupert. If an anthrax attack occurs in the future, having a screening protocol could help prevent overcrowding by allowing patients to be put into lower- and higher-risk categories before they arrive at the ED, he says.

"This paper is, to our knowledge, the first attempt to provide a scientific basis for important bioterrorism-related triage decisions," says Hupert. "ED nurses can rely on information like this to design evidence-based patient management strategies."


1. Hupert N, Bearman GML, Mushlin AI, et al. Accuracy of screening for inhalational anthrax after a bioterrorist attack. Ann Intern Med 2003; 139:337-345.


For more information on triage of patients with possible inhalational anthrax, contact:

Nathaniel Hupert, MD, MPH, Assistant Professor of Public Health and Medicine, Weill Medical College of Cornell University, 411 E. 69th St., Third Floor, New York, NY 10021. Telephone: (212) 746-3049. Fax: (212) 746-8544. E-mail: