While doctors and public health authorities reassure us that the risk of exposure to anthrax is extremely low, many Americans remain anxious.
Warnings about overwhelmed emergency rooms and pledges to increase security seem to be having little effect. When people develop fevers, fatigue and body aches--symptoms shared by the flu and the lethal bacterial infection--they begin to worry: Could this be anthrax? Last week, without a single case identified in the West, Dr. Brian Johnston, director of emergency medical services at White Memorial Medical Center in Los Angeles, said that already people were arriving at the emergency room with concerns they might have anthrax. "They come to the ER with complaints like 'I opened this envelope and got a funny taste in my mouth."'
No cases were found, he said. But a sharp increase in the numbers of such patients--the worried well, in many cases--has been reported nationwide.
The unease about such symptoms is understandable--and it's shared, to some degree, by doctors whose only experience with anthrax is likely to have been in a textbook.
Distinguishing anthrax from other illnesses will be complicated by the winter flu season, because flu, which is very contagious, and anthrax, which is not contagious, get footholds in the respiratory system.
But there are steps patients and doctors can follow to ensure proper treatment, prevent needless panic and avert excess strain on already stressed emergency rooms.
What Patients Can Do
First, consider the symptoms.
Most of the common winter bugs bring low-grade fever, nasal congestion, sore throat and perhaps bronchitis, which usually improve with rest, fluids and maybe some pain and fever reducers. Anthrax is different.
If you wake up feeling as if you've been hit by a Mack truck, with a fever, body aches, headache, and dry cough (but not a runny nose), seek a diagnosis from your doctor or local clinic--especially if you suspect you could have come in contact with anthrax at home or work. Development of symptoms typically occurs within a week of exposure, although it could be in as manyuch as 60 days.
If you have reason to believe you've been exposed, some experts suggest also calling the health department to make sure public officials are aware of the potential health threat. Immediate action is crucial. Anthrax symptoms worsen precipitously after several hours or a few days, resulting in severe breathing problems, meningitis and shock. Untreated it's fatal in 90% of cases. Given early enough, antibiotics can be lifesaving.
The flu has a more stable course, usually resolving itself in several days, with symptoms lingering for a couple of weeks. It responds to some antiviral drugs, although the infection, often complicated by pneumonia, kills 20,000 people each year.
It can take professional detective work to distinguish between anthrax and flu.
"First, call your physician. Don't go to the ER. Don't call 911," stressed Dr. Laurene Mascola, chief of the acute communicable disease control unit for L.A. County's health department.
Your doctor should obtain a detailed health history with information about your recent whereabouts. It's important that he or she know if you work in a mail facility, government office, newsroom or other location where anthrax powder may have been identified.
Although there is no quick anthrax test, you can request one of the quick flu tests that can determine in about 30 minutes whether your illness is either type A or type B flu.
If it's flu, your doctor may prescribe an antiviral medication--not an antibiotic, which doesn't work on viruses and can promote antibiotic resistance.
If your test is negative and your doctor is sufficiently concerned, he or she may order other diagnostic tests. A chest X-ray can show whether your breathing problems stem from pneumonia, in which some areas of the lungs will appear congested.
With anthrax, the chest X-ray will show an enlargement of a structure called the mediastinum, where the spinal cord, heart, blood vessels and lymph nodes come together.
A nasal swab test only shows if you've recently been exposed to anthrax spores, not whether the spores took hold, and generally is most useful to epidemiologists trying to help assess exposure from a particular incident. The test's reliability is still unknown. It's better to have a blood culture, which takes about a day to show results.
If inhalation anthrax is confirmed, according to federal guidelines revised last week, you'll be given two or more antibiotics for 60 days. The primary drug will probably be Cipro or doxycycline, taken for 60 days, and your doctor may add to that such drugs as penicillin, ampicillin, vancomycin or clarithromycin.
