[an error occurred while processing this directive]

Rapid diagnosis and aggressive treatment can drop inhaled anthrax mortality to about 40 percent, studies suggest
Tuesday, Nov. 13, 2001
 
• Anthrax Primer
• Testing for Anthrax
• Anthrax: Quick Facts
By PAUL RECER
AP Science Writer

WASHINGTON – Doctors who recognized the recent cases of inhaled anthrax and treated them aggressively with antibiotics have shown the disease is treatable and not a sure death sentence, experts say.

An analysis of the cases, published in the Journal of the American Medical Association, shows that if doctors speedily give patients a constellation of antibiotics, along with aggressively treating symptoms such as the accumulation of fluid in the chest, there is a high rate of survival. The cases appeared in four eastern U.S. cities in the past few weeks.

"The fact that six of these patients have survived gives hope that the published mortality rates of 86 to 97 percent for inhalational anthrax may not be accurate in the year 2001," Dr. Anthony S. Fauci and Dr. H. Clifford Lane, both of the National Institute of Allergy and Infectious Disease, said in a JAMA editorial last week.

The rate of survival – 60 percent for the recent inhalational cases – could well improve for future infections because doctors across the country now are so aware of anthrax and its symptoms.

"The signs and symptoms of inhalational anthrax are way up on the radar screen of virtually all health care providers now," Fauci, the NIAID director, said in an interview.

Prior to Oct. 4, when a Florida man was hospitalized with the first recognized U.S. case of inhaled anthrax since 1976, the disease was relatively unknown to most American doctors. In medical terminology, inhaled anthrax was not high on the "index of suspicion" in making a diagnosis.

With the intense publicity given the anthrax-by-mail crisis and the publication in journals of specific medical details of the 10 cases, inhaled anthrax has become an infection that doctors will probably consider.

If doctors are practicing in an area where there already is anthrax illness, the possibility of the disease would be at or near the top of the "index of suspicion" for workers who match an existing pattern of infection, said Fauci. In the current pattern, postal, media and Capitol Hill workers were the most likely to be infected with anthrax.

Fauci said the 10 cases also have added important new details about inhaled anthrax infection – symptoms previously unrecognized but which doctors may now consider.

"If you read the textbooks, the disease is not exactly what we are finding," he said.

Doctors have found that patients with inhaled anthrax may not show a raging fever, for instance. Most of the 10 inhaled anthrax patients had normal or only slightly elevated temperatures early in their illnesses.

Abdominal pain, a symptom not previously recognized for the disease, may also be common among inhaled anthrax patients. Irregular heartbeats "disproportionate to the degree of fever" were also reported, Fauci and Lane said.

Doctors also found abnormalities on chest X-rays and CT scans. Most common was an increased density in the area between the two lungs.

"Based on these observations, primary care clinicians should be encouraged to obtain chest radiographs and consider chest CT scanning to aid in the diagnostic workup of patients in whom inhalational anthrax is a diagnostic consideration," they said.

___

On the Net:

JAMA: http://jama.ama-assn.org

NIAID: www.niaid.nih.gov
[an error occurred while processing this directive]