Last Updated

13 Jul 2003

Source: Wall Street Journal, May 1, 2002.

HEALTH

Researchers Say Anthrax Is Less Fatal Than Feared

By MARILYN CHASE, Staff Reporter of THE WALL STREET JOURNAL

Last fall's lethal anthrax attack showed the disease needs aggressive treatment with a battery of drugs, but researchers say it is more treatable and less fatal than previously feared.

Antibiotic cocktails of two or three drugs beat single-drug treatment, according to a report in this week's Journal of the American Medical Association. Ciprofloxacin and doxycycline remain the first-line drugs; other options include rifampin, vancomycin and penicillin.

"It appeared survivors were on multiple antibiotics," said the report's lead author, Thomas Inglesby, deputy director of the Center for Civilian Biodefense Strategies at Johns Hopkins University in Baltimore. "But the numbers are small and there were other variables, such as the time it took to initiate treatment."

For people who have been exposed to anthrax , the best preventive regimen would be 60 days of antibiotics plus the anthrax vaccine. The vaccine, made by Bioport Corp. of Lansing, Mich., is "as safe as other [vaccines] that are licensed," said Dr. Inglesby. But the shots offered last fall had few takers due to fears of side effects. Research is now under way to develop a new anthrax vaccine using genetic engineering.

In an effort to help doctors recognize a disease that most have never seen, the report also includes a chest X-ray of an anthrax victim, as well as a photo showing the black scab of skin anthrax . Anthrax triggers hemorrhaging of the lymph nodes in the chest, along with fluid leaks into the space around the lungs, abnormalities that are visible in chest X-rays and CT scans.

For the victims of last fall's anthrax attacks, the most common symptoms were fever and malaise with cough, nausea, sweats, chest pain, shortness of breath and headache.

The most useful microbiologic test remains the standard blood culture. Despite the imperative of early treatment, the report emphasized that it's crucial to get a culture before starting drugs, since as little as a single dose of antibiotics can turn a blood test negative, obscuring the cause of infection. That could lead to misdiagnosis, incorrect treatments and public health confusion.

The report dismissed the widely held belief that anyone who inhaled spores of the bacteria must start treatment before symptoms appear or face inevitable death.

"It's not the case that once you have symptoms, you're beyond help," said Dr. Inglesby in an interview. Although treatment should begin as early as possible, he noted, "Six cases of inhalational anthrax were sick enough to seek treatment, and yet they still recovered."

Of 11 inhalational anthrax cases last fall, five patients, or about 45%, died -- roughly half the 89% death rate seen decades ago among U.S. wool and tannery workers who contracted inhalational anthrax from exposure to infected animal skins.

While 11 cases were too small to prove a statistically significant plunge in mortality, Dr. Inglesby said, "We can save a lot of people from anthrax through treatment."