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Fast Response Foils Anthrax, Study Finds


Modern medicine has made inhalation anthrax a curable disease, but only if the illness is diagnosed early and treated quickly, the Journal of the American Medical Assn. reported Monday.

Six of the 10 patients who have contracted the infection in the last six weeks have survived. That has cast doubt on the continued relevance of earlier research showing death rates of 90% or higher.

"Because of the advances in imaging, microbiology, antibiotics and critical care, certain patients have survived who, in a different era, almost certainly would have succumbed to this disease," Dr. Anthony S. Fauci and Dr. H. Clifford Lane, both of the National Institute of Allergy and Infectious Disease, wrote in a journal editorial.

With aggressive antibiotic treatments, "inhalational anthrax is a serious but nonetheless treatable disease," they wrote.

The editorial will be published in the journal's Nov. 28 issue along with case histories of four postal workers in Washington who developed inhaled anthrax--two who lived and two who died. The journal released the articles in advance of publication because of their influence on health decisions.

Doctors and hospitals have learned a tremendous amount about anthrax since Oct. 5, when Bob Stevens, a photo editor for a tabloid newspaper in Florida, died after inhaling the bacteria. His was the first case of inhaled anthrax in the United States since 1976.

Since his death, experts have concluded that alertness and quick judgment by doctors and nurses is critical to the public health response to anthrax and bioterrorism threats, Fauci and Lane wrote.

The four patients described in the histories showed common symptoms when they sought medical care: an abnormally rapid heart rate, normal or elevated white blood cell count and abnormalities on chest X-rays and CT scans. Three of the four also noted abdominal pain or chest discomfort.

The two patients who died had fluid buildup in their chest and had an enlarged area in their chests common in inhaled anthrax infections. Blood cultures showed long chains of the anthrax bacterium.

The earlier that infected patients begin receiving intravenous antibiotics, the better their prognosis, according to the case studies. The two postal workers who survived entered the hospital Oct. 19 and 20. The two who died were admitted Oct. 21 and 22. Officials assume that all four were exposed about the same time.

Fauci and Lane stress the importance of doctors asking patients about their occupations. All four people worked at the giant Brentwood mail processing facility outside Washington, D.C., which handled the contaminated letter to Senate Majority Leader Tom Daschle (D-S.D.).

The two deceased patients sought treatment for flu-like symptoms and both were sent home. At the time, officials had not yet warned that postal workers were at greater risk than the public. Critics have said that the delay in the warning could have cost their lives.

"Laboratory tests should be ordered if there is any suspicion of anthrax,' said Dr. Luciana Borio, lead author of one of the journal articles. "It's essential that doctors are familiar with how anthrax presents in order to distinguish it from more common infections."

The bacteria, Bacillus anthracis, can enter the body in three ways: through the skin, by inhalation or by eating food contaminated with it. None of the seven cutaneous anthrax cases identified in the last six weeks has been fatal.

Once in the lungs, anthrax bacteria grow out of control, sending their host into shock. The bacteria also release a toxin that kills key immune cells, leaving the body more vulnerable to infection. When those immune cells die, they spill further toxins into the blood.

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