Recognition of community-acquired anthrax: Has anything changed since 2001?

Objective: To compare responses of practicing military and civilian primary care physicians to a series of standardized inhalational anthrax cases. Methods: A series of three randomly selected case vignettes adapted from the 2001 anthrax attack along the East Coast of the United States were mailed to a convenience sample of community-based primary care physicians. Respondents were asked to list differential diagnoses along with initial management and treatment plans. Results: The response rate was 55% (n = 164). The most common diagnoses were pneumonia and influenza. Few (n = 6) physicians included anthrax in their differential diagnosis. Conclusions: Anthrax remains low on the list of differential diagnoses in the setting of community-acquired respiratory illness.