- The Washington Times - Wednesday, October 24, 2001

Anthrax is a deceptive disease a mimic that in two of its forms and in its early stages resembles illnesses that almost everybody experiences from time to time. That means it is hard to diagnose.

"At first anthrax even the worst, inhaled form causes little pain. The pain is related to having a headache or abdominal pain pains that most people have had before with other illnesses. There's not a clue that this is pain out of proportion to what the patient had experienced before," says Dr. David J. Sullivan of the Johns Hopkins Bloomberg School of Public Health.

Dr. Sullivan, a molecular biologist and immunologist, says physicians would be hard-pressed to diagnose a case of inhaled anthrax poisoning based only on the vague, flulike symptoms of the disease unless there was reason to suspect the patient might have been exposed to anthrax spores.

News of anthrax exposures has dominated the media for weeks. Nonetheless, Dr. Sullivan suggests the ambiguity of the early symptoms may explain why anthrax victim and D.C. postal worker Joseph P. Curseen, 47, was turned away when he first visited the Southern Maryland Medical Center emergency room in Clinton.

Mr. Curseen went to the hospital on Sunday. He was sent home and told to return if he felt worse. He soon felt worse, returned Monday morning with flulike symptoms and died six hours later. The hospital had no comment other than to confirm the "47-year-old" was treated and died.

Anthrax attacks in three ways: through scrapes and cuts in the skin, through contaminated food, and through the lungs when the spores of the bacterium (Bacillus anthracis) are inhaled.

As anthrax is doing now and has done most often in its long history, it is infecting victims mainly through skin contact. Within five days of exposure to the bacterium, the anthrax produces a sort of blister rimmed with red that looks like a mosquito bite.

The bump called cutaneous anthrax is not particularly uncomfortable at that point. But as the disease progresses, the bump mutates into an open sore with a black center of dead tissue.

"At this point, the skin disease is readily diagnosed" and satisfactorily treated with antibiotics, says Dr. Sullivan. If left untreated, the disease may affect lymph nodes and eventually infect the blood, which can be fatal.

Ingested anthrax is less common than cutaneous anthrax. It occurs when the victim eats inadequately cooked meat. Like inhaled anthrax, it is hard to detect because of its common symptoms and is treatable with antibiotics.

One of the tricky things about inhaled anthrax, says Dr. Sullivan, is the erratic course the symptoms can take.

"The first stage of the disease, when the patient has a fever, cough, headache, weakness and chest pain, can last for a couple of hours or a couple of days. Some people recover from this stage and seem well," the doctor says. But, he continues:

"The second stage presents a really sick patient with high fever and shock. The body reacts as it does when assaulted with bacteria and viruses, and it loses blood pressure. Even then it's hard to distinguish whether anthrax is causing the problem or just another infection with other bacteria."

The disease is diagnosed through lab tests that isolate Bacillus anthracis from skin lesions, respiratory secretions or antibodies in the patient's blood. Test results take several days.

The treatment in almost all instances is to administer antibiotics, and to do so quickly. Treatment after the first 24 to 48 hours of exposure has been ineffective in the past. Yet the recent rash of exposures is causing physicians to believe later treatment may be more effective than once thought. Previously and on average, 80 percent of inhalation anthrax victims have died.

Cipro has been the antibiotic of choice, especially for initial therapy. But Surgeon General David Satcher and other doctors insist other common antibiotics like penicillin, streptomycin and tetracycline work equally well.

For people known to have been exposed and especially for those thought to be incubating the disease, antibiotics are prescribed for up to 60 days, depending on the amount of exposure. Some who were in areas that might have been contaminated were being treated for as few as 10 days.

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