Inhalation Anthrax Deaths-NEWS
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– Hide quoted text — Show quoted text -> "And that’s the biggest weakness in our public-health system right now. > Most primary-care physicians and nurse practitioners are CLUELESS about how > to diagnose anthrax, plague, tularemia, and smallpox, since they’ve never > seen a case before. > I think the better way to state this is that they have not been made > aware of the increased risk so that they will test for it. I do believe they > know HOW just have not had much call for it…. > Not true. > The magazine U.S. News reported on one survey of a dozen ER physicians, > who were presented with a hypothetical case of a patient with coughing, > nausea, and a blistering rash that started in the face and spread down > to the torso. > Out of these dozen physicians, ONLY ONE made the correct diagnosis: > smallpox.
That is really of little consequence since there is no treatment for smallpox. You are correct, that docs these days are inexperienced in the recognition and treatment of these agents. In the case of pulmonary anthrax the problem is that the prodrome is indistinguishable from the flu. The only clue that it may be anthrax would be a history of exposure, which the postal worker was not known to have at the time. After the flu-like illness there is frequently a few days of apparent recovery, which most would take to be a good sign. By the time the sudden and severe respiratory symptoms return the disease is serious with a high mortality rate (quoted as 85-90% but I don’t think we have reliable statistics with the current standards of care). A lot of medical practice relies on epidemiology and playing the odds. The saying "common things happen commonly," and, "an uncommon presentation of a common disease is more likely than a common presentation of an uncommon disease," have stood the test of time. Unfortunately, the first people in any unusual outbreak will probably have a delay in diagnosis. Once the new set of likelihoods for the disease are understood the recognition will happen faster (with more false alarms along the way). The only alternative would be to treat every case of flu as if it were anthrax. There is just no way that is possible. BTW oral Cipro achieves serum levels comparable to IV so, in the case of this antibiotic, the route of administration is not the issue (not true for penicillin or doxycycline). The hospitalization is more for observation and due to the rapidity of respiratory collapse with anthrax. — CBI, MD
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> > CNN now reported that at least one of these men had asthma: > http://www.cnn.com/2001/US/10/22/anthrax.victim/ > I’m not surprised. > For an asthmatic, inhalation anthrax is likely to be a death sentence, > even with antibiotics. > It can be a death sentence for anyone not treated until symptoms show > up. It’s usually too late by then as I understand it….
Not quite. If you are admitted to the hospital as soon as symptoms show up, they can put you on INTRAVENOUS antibiotics and that may be enough to pull you through. That’s how the second guy in Florida with inhalation anthrax survived. He was discharged from the hospital today! The problem with the postal worker, besides the asthma, is that he went to the emergency room where the doctor misdiagnosed him as having the flu. And that’s the biggest weakness in our public-health system right now. Most primary-care physicians and nurse practitioners are CLUELESS about how to diagnose anthrax, plague, tularemia, and smallpox, since they’ve never seen a case before. — Steven D. Litvintchouk 9-11. Answer the call!
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"And that’s the biggest weakness in our public-health system right now. Most primary-care physicians and nurse practitioners are CLUELESS about how to diagnose anthrax, plague, tularemia, and smallpox, since they’ve never seen a case before. I think the better way to state this is that they have not been made aware of the increased risk so that they will test for it. I do believe they know HOW just have not had much call for it. Now, of course, we all know the need. Denise Indianapolis
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> "And that’s the biggest weakness in our public-health system right now. > Most primary-care physicians and nurse practitioners are CLUELESS about how > to diagnose anthrax, plague, tularemia, and smallpox, since they’ve never > seen a case before. > I think the better way to state this is that they have not been made > aware of the increased risk so that they will test for it. I do believe they > know HOW just have not had much call for it….
Not true. The magazine U.S. News reported on one survey of a dozen ER physicians, who were presented with a hypothetical case of a patient with coughing, nausea, and a blistering rash that started in the face and spread down to the torso. Out of these dozen physicians, ONLY ONE made the correct diagnosis: smallpox. — Steven D. Litvintchouk Disclaimer: As far as I am aware, the opinions expressed herein are not those of my employer.
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> 2 D.C. Postal Workers Die; Anthrax Likely 10-23-01 > WASHINGTON — Two postal workers in the nation’s > capital have died of suspected inhalation anthrax, > prompting health officials to acknowledge Monday that > some of their key assumptions about how the deadly > bacterium is spread may prove to be wrong. > District of Columbia officials announced the deaths of the > two men, even as their co-workers waited in line at a local > hospital to be tested for exposure to anthrax. Homeland > security chief Thomas J. Ridge later said, "Their deaths > are likely due to anthrax."
CNN now reported that at least one of these men had asthma: http://www.cnn.com/2001/US/10/22/anthrax.victim/ I’m not surprised. For an asthmatic, inhalation anthrax is likely to be a death sentence, even with antibiotics. — Steven D. Litvintchouk Disclaimer: As far as I am aware, the opinions expressed herein are not those of my employer.
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> CNN now reported that at least one of these men had asthma: > http://www.cnn.com/2001/US/10/22/anthrax.victim/ > I’m not surprised. > For an asthmatic, inhalation anthrax is likely to be a death sentence, > even with antibiotics.
It can be a death sentence for anyone not treated until symptoms show up. It’s usually too late by then as I understand it. You can kill the organism, but the toxins remain and that’s what kills you.
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Inhalation anthrax cases may not mean certain death BY LAWRENCE K. ALTMAN New York Times People with inhalation anthrax may survive if their cases are diagnosed promptly and if they receive aggressive treatment in the early stages of the infection, experts in infectious disease say, basing their opinions partly on the course of the illness in two of the cases diagnosed this month. Dr. Frank Bia, an infectious disease specialist and microbiologist at Yale University, said inhalation anthrax might be like other bacterial infections that respond to treatment if antibiotic treatment is started in time. Although Robert Stevens, 63, died of inhalation anthrax, a co-worker in Florida, Ernesto Blanco, 73, is gradually recovering. Blanco, his co-worker at American Media in Boca Raton, Fla., is recovering at Cedars Medical Center in Miami after leaving an intensive care unit, where he had been on a respirator. Anthrax was not suspected when Blanco, who suffers from chronic lung disease, was admitted to Cedars for pneumonia on Oct. 1. The underlying lung disease may have made him more susceptible to inhalation anthrax. Because he worked at American Media, a swab of his nose was taken, and it showed anthrax spores. Later tests showed evidence of Bacillus anthracis in bloody fluid in the sac covering his lungs. Dr. Larry M. Bush, who treated Stevens, the man who died of inhalation anthrax in Florida, said his patient might never have developed inhalation anthrax if he had followed his wife’s advice to seek medical attention when he first developed symptoms about Sept. 26, instead of waiting until Oct. 2. If Stevens had sought help earlier, a doctor would have realized he had a respiratory infection but probably would not have considered anthrax. Nevertheless, an antibiotic prescribed for a respiratory infection would probably have successfully treated his inhalation anthrax, Bush said in an interview. –MORE– http://www0.mercurycenter.com/premium/nation/docs/treatment23.htm – Hide quoted text — Show quoted text – > 2 D.C. Postal Workers Die; Anthrax Likely 10-23-01 > http://www.latimes.com/news/nationworld/world/la-102301anthrax.story
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Steps taken to safeguard mail handlers The latest anthrax cases, including the deaths Monday of two Washington postal employees believed to have been infected, have prompted immediate changes in mail-handling methods in California and raised questions about how well-prepared doctors are to detect signs of the disease. Augustine Ruiz, a spokesman for the U.S. Postal Service’s sprawling mail-processing plant in North San Jose, said officials have suspended the routine practice of using high-pressure air to blow dust and other debris out of the plant’s various sorting machines. “We are only going to vacuum” the machines from now on, Ruiz said, a method preferred by union officials for health reasons. He also said he understood that blowing was suspended Monday at many other — if not all — postal facilities in the state. It was not clear Monday if similar changes would happen nationwide. Ruiz also said gloves and masks are now available to many local postal employees, after some workers complained last week that a previous policy prohibited gloves. Bob Williamson, president of the American Postal Workers Union in San Francisco, said he has been pushing for the change long before the terrorist attacks, because of fears that blowing even dust out of the machines might harm people with asthma or other health problems. “People have been complaining about it for years,” he said. “It’s done daily” on every major machine in San Francisco’s mail-processing plant, he said. After blowing, he said, the dust is so thick in the air around the machines “you can see it and you can taste it.” –MORE– http://www0.mercurycenter.com/premium/front/docs/locanthrax23.htm – Hide quoted text — Show quoted text – > 2 D.C. Postal Workers Die; Anthrax Likely 10-23-01 > http://www.latimes.com/news/nationworld/world/la-102301anthrax.story
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2 D.C. Postal Workers Die; Anthrax Likely 10-23-01 WASHINGTON — Two postal workers in the nation’s capital have died of suspected inhalation anthrax, prompting health officials to acknowledge Monday that some of their key assumptions about how the deadly bacterium is spread may prove to be wrong. District of Columbia officials announced the deaths of the two men, even as their co-workers waited in line at a local hospital to be tested for exposure to anthrax. Homeland security chief Thomas J. Ridge later said, "Their deaths are likely due to anthrax." If anthrax is confirmed as the cause of death, the men, ages 47 and 52, would be the second and third victims killed by the infection since the biological warfare agent first surfaced at a Florida tabloid office less than three weeks ago. The men’s names were not immediately released. Their deaths raised particular concerns because they may have succumbed to inhalation anthrax–the most lethal form of the disease–simply by working in a facility that handled contaminated mail. In addition to the cases of the two who have died, officials are concerned about two confirmed cases of inhalation anthrax among Washington postal workers and about two New Jersey postal workers who have the more treatable skin form. The inhalation cases involve a dock supervisor and a courier at Washington’s Brentwood central processing facility. The two were in serious condition Monday. Nine additional Washington postal employees appear to have been exposed to anthrax. Key evidence may be found in the results of lab tests on the two men’s bodies to determine whether they died of anthrax. A preliminary blood culture from one of the victims came back "positive for anthrax," said Ivan Walks, director of the District of Columbia Health Department. While health officials were still awaiting final test results Monday night, Ridge told reporters at a news conference that "it is very clear that their symptoms are suspicious and their deaths are likely due to anthrax." Both men experienced severe respiratory problems before becoming critically ill and dying at separate hospitals in the Washington area, Ridge said. Authorities did not identify the victims. One was a 47-year-old man who worked in the automated-sorting section of the mail facility. He went to the Southern Maryland Medical Center at 2 a.m. Sunday after fainting in church Saturday. Doctors were unaware that he worked at a postal facility, and his complaints–abdominal cramps and nausea–were not typical of the flu-like symptoms associated with anthrax, said Dr. Venkat Mani, head of the hospital’s infectious diseases department. The man’s vital signs were stable, and he was diagnosed with a gastric disorder and sent home, Mani said. He was rushed back to the hospital early Monday morning, where he was treated with high doses of antibiotics. He died later in the day. Mani said that even if doctors had known that the victim worked for the postal service, that would "probably not" have saved him. "Even with the best treatment, the mortality rate [for inhalation anthrax] is 80% to 85%. . . . If this person had said, ‘I work at the postal facility,’ perhaps the physician would have done a nasal swab to test for anthrax exposure. But even then, the test results would have taken 24 to 48 hours." The second victim, a 52-year-old man, died at Greater Southeast Hospital on Sunday night after he was treated for possible anthrax exposure, the hospital said. He was believed to have worked in the section that handled government mail. http://www.latimes.com/news/nationworld/world/la-102301anthrax.story
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