Text: NIH Publishes Anthrax Findings

14 November 2001

Text: NIH Publishes Anthrax Findings

Should help doctors distinguish anthrax from common infections

Researchers have published a detailed assessment of the fatal cases of inhalation anthrax that struck two U.S. postal workers in an effort to make doctors aware of what to look for when diagnosing suspected anthrax patients.

According to a November 12 press release by the National Institutes of Health (NIH), the findings will be published in the November 28 issue of the "Journal of the American Medical Association," and are currently posted at the following Web site: http://www.jama.com

The two anthrax victims were among five postal workers that worked at the Brentwood postal facility in Washington, D.C., and contracted anthrax in October. One had gastrointestinal symptoms, including nausea, and the other had flu-like symptoms.

According to NIH researcher Dr. Luciana Borio, the two workers' symptoms were initially misidentified as flu, but a later review of the laboratory data showed pathology different from common infections. Both patients' blood tests showed increased white blood cell counts and concentrated red blood cell counts - neither normally seen in flu patients. Also, blood cultures showed long chains of the distinctive anthrax bacilli.

"It's essential that doctors are familiar with how anthrax presents in order to distinguish it from more common infections," Borio said. She added that neither patient had symptoms that would normally require further tests or hospitalization, so they were initially sent home.

The researchers said that the analysis and prompt publication of the latest findings would help doctors avoid such tragic consequences in the future.

Following is the text of the NIH press release:

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NATIONAL INSTITUTES OF HEALTH
Warren Grant Magnuson Clinical Center

NIH NEWS RELEASE
Monday, November 12

ANTHRAX FINDINGS PRESENTED BY NIH RESEARCHER

An NIH Clinical Center researcher, in collaboration with physicians in Maryland and Washington DC, has published a detailed assessment of the fatal cases of inhalational anthrax that occurred in two District of Columbia postal workers. The findings, which will be published in the Nov. 28 issue of the "Journal of the American Medical Association," have been posted ahead of publication at http://www.jama.com because of their public health importance.

"These results are presented in an effort to make doctors aware of what to look for when diagnosing suspected anthrax patients," said Dr. Luciana Borio, lead author of the paper. Borio, who is fellow in the Critical Care Medicine Department of the NIH Clinical Center and researcher at the Johns Hopkins Center for Civilian Biodefense Studies, published the findings in collaboration with physicians at the Greater Southeast and Southern Maryland Hospitals, and the DC and Maryland Medical Examiners Office. An accompanying editorial by Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAID) and H. Clifford Lane, MD, NIAID Clinical Director, is also posted on the JAMA website.

Because the symptoms in these two cases were nonspecific, they were initially misidentified as flu or other common infections. However, a later review of the laboratory data showed pathology different from common infections, according to Borio. Both patients' blood tests showed increased white blood cell counts and concentrated red blood-cell counts. Neither finding would normally be seen in flu patients, said Borio. In addition, blood cultures quickly showed long chains of the distinctive anthrax bacilli.

"Laboratory tests should be ordered if there is any suspicion of anthrax," Borio stressed. "Both cases show the importance of testing by microbiology laboratories with staff experienced in growing and identifying these unusual organisms."

Both postal workers also developed fluid build up in the chest and infiltrates in the lungs that resembled pneumonia on radiologic images. "It would have been easy to misdiagnose these cases as pneumonia, and thus rule out anthrax, if doctors had relied on the x-rays alone," said Borio.

"It's essential that doctors are familiar with how anthrax presents in order to distinguish it from more common infections," said Borio. "Both patients were sick enough to seek medical help," she said, "but neither had symptoms that would normally require further tests or hospitalization, so they were initially sent home."

The two anthrax victims were among five postal workers who worked at the Brentwood postal facility in Washington who contracted anthrax in October. One had gastrointestinal symptoms, including nausea, vomiting and stomach pain. The other had flu-like symptoms, including muscle ache, discomfort and fatigue. Both developed chest pain and breathing difficulty, eventually requiring a respirator.

Doctors made a working diagnosis of anthrax after the media reported two other postal workers from the same facility were diagnosed with anthrax. Although both were treated with antibiotics, both died within 24 hours of hospitalization.

"Without warning that anthrax was present in the community, doctors would be unlikely to consider such a rare condition," said Dr. Henry Masur, chief of critical care medicine at the NIH Clinical Center. "The analysis and prompt publication of these findings will help doctors avoid such tragic consequences in the future."

Other authors contributing to this study were Dennis Frank, MD; Venkat Mani, MD; Carlos Chiriboga, MD; Michael Pollanen, MD, PhD; Mary Ripple, MD; Syed Ali, MD; Constance DiAngelo, MD, MS; Jacqueline Lee, MD; Jonathan Arden, MD; Jack Titus, MD; David Fowler, MD; Tara O'Toole, MD, MPH; John Bartlett, MD; and Thomas Inglesby, MD.

The Warren Grant Magnuson Clinical Center is a component of the National Institutes of Health (NIH). The Clinical Center is the clinical research hospital for NIH. Through clinical research, physicians and scientists translate laboratory discoveries into better treatments, therapies and interventions to improve the nation's health.

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