Inhalational anthrax may need to be distinguished from community-acquired pneumonia (CAP). Kuehnert et al developed a score to help distinguish inhalational anthrax from bacterial pneumonia. The authors are from CDC.
Parameters:
(1) serum ALT and AST
(2) heart rate
(3) WBC count
(4) nausea or vomiting
(5) serum sodium
Parameter
Finding
Points
serum ALT and ALT
both elevated
1
both not elevated
0
heart rate
tachycardia (> 100 beats per minute)
1
normal or bradycardia
0
WBC count
normal
1
increased
0
nausea or vomiting
present
1
neither
0
serum sodium
low
1
normal or increased
0
where:
• The points assigned correspond to the strength of association in multivariate analysis.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum total score: 0
• maximum total score: 5
• The higher the score the more specific the diagnosis of inhalation anthrax but the lower the sensitivity.
Performance:
• A score >= 2 was 100% sensitive but 48% specific.
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