{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T03:15:38Z","timestamp":1783480538225,"version":"3.55.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prevalence of pleural, pericardial, or peritoneal effusions among anthrax patients is unknown, as is the impact of drainage on mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified hospitalized anthrax patients with effusions published 1920\u20132018 worldwide (N = 1108), excluding cases with insufficient clinical data. Two manuscript authors independently abstracted fluid collection and morbidity data. We evaluated how effusion drainage impacted mortality using logistic regressions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Effusions were present in 99 (13%) of 744 eligible anthrax patients; 65 (66%) of these died. Pleural effusions developed in 72% of patients with inhalation anthrax (N = 61), most often bilaterally. Similarly, 55% of ingestion anthrax patients (N = 55) developed peritoneal effusions. Pericardial effusions were rare (1.7%). Most pleural Gram stains or cultures obtained pre-antimicrobials were positive (83%). Of the 44 patients with clinically significant pleural effusions, only 59% received drainage. Drainage of these effusions was associated with survival (odds ratio [OR] 38.3, 95% confidence interval [CI]: 4.3\u2013339.0), even when controlling for antimicrobials and\/or antiserum. Most patients with fatal outcomes following drainage had either bilateral effusions with single-sided drainage or effusion recurrence. Although drainage of clinically significant peritoneal effusions was not associated with survival, laparotomy \u00b1 resection for peritonitis was associated (OR 53.6, 95% CI: 9.4\u2013inf).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pleural drainage appears associated with survival. Most inhalation anthrax patients develop bilateral collections, and may require chest-tube insertions. Surgical source control is associated with survival for anthrax-associated peritonitis. Following a wide-area release of Bacillus anthracis, public health authorities should anticipate many patients may require source control (eg, chest tube drainage or surgery) and plan accordingly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag113","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T12:57:43Z","timestamp":1771505863000},"page":"e1184-e1193","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Characteristics and Survival of Hospitalized Anthrax Patients with Pleural, Pericardial, or Peritoneal Fluid Collections"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7533-6164","authenticated-orcid":false,"given":"Jon-Erik C","family":"Holty","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, VA Palo Alto Healthcare System , Stanford, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa K","family":"Person","sequence":"additional","affiliation":[{"name":"Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6154-3074","authenticated-orcid":false,"given":"Sophie","family":"Binney","sequence":"additional","affiliation":[{"name":"Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Cook","sequence":"additional","affiliation":[{"name":"Cherokee Nation Integrated Health, Office of Readiness and Response, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thitipong","family":"Mongkolrattanothai","sequence":"additional","affiliation":[{"name":"CDC Fellowship Program, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Oak Ridge Institute for Science and Education , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Kirpich","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, School of Public Health, Georgia State University , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6900-745X","authenticated-orcid":false,"given":"Caroline A","family":"Schrodt","sequence":"additional","affiliation":[{"name":"Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention , Atlanta, Georgia 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