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      The National Capitol Region’s Emergency Department Syndromic Surveillance System: 
Do Chief Complaint and Discharge Diagnosis Yield Different Results?

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          Abstract

          We compared syndromic categorization of chief complaint and discharge diagnosis for 3,919 emergency department visits to two hospitals in the U.S. National Capitol Region. Agreement between chief complaint and discharge diagnosis was good overall (kappa=0.639), but neurologic and sepsis syndromes had markedly lower agreement than other syndromes (kappa statistics 0.085 and 0.105, respectively).

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          Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States.

          From October 4 to November 2, 2001, the first 10 confirmed cases of inhalational anthrax caused by intentional release of Bacillus anthracis were identified in the United States. Epidemiologic investigation indicated that the outbreak, in the District of Columbia, Florida, New Jersey, and New York, resulted from intentional delivery of B. anthracis spores through mailed letters or packages. We describe the clinical presentation and course of these cases of bioterrorism-related inhalational anthrax. The median age of patients was 56 years (range 43 to 73 years), 70% were male, and except for one, all were known or believed to have processed, handled, or received letters containing B. anthracis spores. The median incubation period from the time of exposure to onset of symptoms, when known (n=6), was 4 days (range 4 to 6 days). Symptoms at initial presentation included fever or chills (n=10), sweats (n=7), fatigue or malaise (n=10), minimal or nonproductive cough (n=9), dyspnea (n=8), and nausea or vomiting (n=9). The median white blood cell count was 9.8 X 10(3)/mm(3) (range 7.5 to 13.3), often with increased neutrophils and band forms. Nine patients had elevated serum transaminase levels, and six were hypoxic. All 10 patients had abnormal chest X-rays; abnormalities included infiltrates (n=7), pleural effusion (n=8), and mediastinal widening (seven patients). Computed tomography of the chest was performed on eight patients, and mediastinal lymphadenopathy was present in seven. With multidrug antibiotic regimens and supportive care, survival of patients (60%) was markedly higher (<15%) than previously reported.
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            Plague. A clinical review of 27 cases.

            We reviewed the medical records of 27 patients with plague seen at the Gallup (NM) Indian Medical Center between 1965 and 1989. Nineteen patients had bubonic plague and eight had septicemic plague. Three patients with septicemic plague and three with bubonic plague died. The patients presented with five different clinical pictures. Ten patients presented with classic signs of plague, five with the appearance of an upper respiratory tract infection, five with a nonspecific febrile syndrome, four with the appearance of a gastrointestinal or urinary tract infection, and three with the appearance of meningitis. Blood cultures were positive in 24 of 25 cases, and bubo aspirate cultures were positive in 10 of 13 cases. All six patients who died were under 30 years old, and all the deaths were related to a failure to treat initially with an antibiotic appropriate for plague. Plague is a treatable disease, but clinicians must have a high index of suspicion and give appropriate antibiotics at the earliest possible time to patients whose presentation suggests plague.
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              Recognition of illness associated with the intentional release of a biologic agent.

              (2001)
              On September 11, 2001, following the terrorist incidents in New York City and Washington, D.C., CDC recommended heightened surveillance for any unusual disease occurrence or increased numbers of illnesses that might be associated with the terrorist attacks. Subsequently, cases of anthrax in Florida and New York City have demonstrated the risks associated with intentional release of biologic agents. This report provides guidance for health-care providers and public health personnel about recognizing illnesses or patterns of illnessthat might be associated with intentional release of biologic agents.
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                Author and article information

                Journal
                Emerg Infect Dis
                EID
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                1080-6040
                1080-6059
                March 2003
                : 9
                : 3
                : 393-396
                Affiliations
                [* ]Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
                []Virginia Department of Health , Richmond, Virginia, USA
                []District of Columbia Department of Health, Washington, D.C., USA
                [§ ]Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA
                Author notes
                Address for correspondence: David Blythe, Epidemiology and Disease Control Program, Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201, USA; fax: 410-669-4215; e-mail: dblythe@ 123456dhmh.state.md.us
                Article
                02-0363
                10.3201/eid0903.020363
                2958546
                12643841
                67612056-7b75-4e8a-ae2c-edbe4f3793ea
                History
                Categories
                Dispatch

                Infectious disease & Microbiology
                public health,dispatch,emergency services,hospital,bioterrorism,population surveillance/methods

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