FLORIDA MAN DIES OF RARE FORM OF ANTHRAX
22 Aug 2003
Source: New York Times, October 6, 2001
Florida Man Dies of Rare Form of Anthrax
By DANA CANEDY with NICHOLAS WADE
LANTANA, Fla., Oct. 5 -- A 63-year-old Florida man who had been hospitalized with pulmonary anthrax on Tuesday died today, state health officials said.
Officials from the federal Centers for Disease Control and Prevention said the case seemed to have been an isolated one with natural causes. Still, as a now-routine precaution during a time of extreme concern, they are considering the possibility it was the result of a terrorist act.
''I don't think we want to give anyone the idea that we have even the slightest inkling of an idea what could have caused this disease,'' said Dr. Steven Wiersma, an epidemiologist with the state health department. ''We have a team of 50 people -- state, local, federal health department officials, as well as C.D.C. -- in Lantana working on the investigation.''
Though anthrax cannot be passed from one person to another, a coworker of the man who died, Robert Stevens, a photo editor at the supermarket tabloid Sun who inhaled the spores, has been hospitalized and is being tested for the disease.
''The symptoms we are seeing are not those typical of inhalation anthrax,'' Dr. Jeffrey P. Koplan, director of the federal disease agency, said of Mr. Stevens's co-worker, ''but, nevertheless, we have a variety of tests we are processing to make sure it is not anthrax.''
Investigators have examined the charts of more than 100 patients in area hospitals with severe infections, but they said they had found no other cases of anthrax.
They are also testing and monitoring Mr. Stevens's wife, relatives and anyone else who had recent and regular contact with him. So far, the authorities said, there were no indications that any of those people had been infected.
Officials said that Mr. Stevens went to North Carolina to visit his daughter and her boyfriend on Sept. 28 and returned home a couple of days later. Health officials in North Carolina are helping in the investigation, in which epidemiologists are tracing Mr. Stevens's activities for the past 60 days.
Today, a team of specialists searched his one-story, ranch-style house here, which was surrounded by crime-scene tape. They took samples of dirt from the backyard where Mr. Stevens tended a garden to test for bacterial spores which can persist in soil for years. Investigators also took fertilizer sprays and pesticide bottles from the house.
Agents of the Federal Bureau of Investigation were at the house as the scientists collected evidence, though a spokeswoman for the bureau said investigators were conducting a public health probe, not a criminal one.
''We're out there following them just in case anything is found,'' Judy Orihuela, the spokeswoman, said.
Officials have also enlisted the aid of local veterinarians to try to determine if animals in the area are infected with the disease.
Dr. Martin Hugh-Jones, an anthrax expert at Louisiana State University, said he strongly doubted a suggestion that Tommy G. Thompson, the secretary of health and human services, made on Thursday that Mr. Stevens had caught anthrax from spores on his clothes or drinking water from a creek.
Anthrax is widespread in the western United States but has not been found east of the Mississippi in decades, Dr. Hugh-Jones said.
Still, anthrax can live in the soil for decades and could persist in Florida, even though the last known case there was 28 years ago, Dr. Koplan said. The spores, which are release by the bacteria, can also be carried in bone meal, which is often used as a fertilizer.
Even so, the spores are quickly killed in sunlight, one reason it is hard to explain the oddest feature of the Stevens case. More than 95 percent of anthrax cases are contracted through the skin, often by people who have handled infected animals or their hides.
But pulmonary cases, like Mr. Stevens's, require inhaling a large dose -- 8,000 to 10,000 spores -- usually in enclosed spaces protected from direct sunlight, like bone meal production plants, wool factories or laboratories where the bacteria is studied.
Only 18 cases of pulmonary anthrax have been reported in the United States in the last 100 years, 2 of which involved laboratory workers.
Because the disease's incubation period varies from one to 60 days, Dr. Koplan said officials at the Centers for Disease Control were ''paying great attention to every place'' Mr. Stevens had been in the two months before developing it. Still, he added, ''last I heard, I was not aware of visits to such places.''
Dr. Koplan said that the center was screening the region for other cases of anthrax, considering anyone who has anthraxlike symptoms or who received a blood test or lumbar puncture.
He said that it was now the C.D.C.'s routine policy not to rule out terrorism but that no reason had yet been presented to suggest that Mr. Stevens's case had an other-than-natural cause.
Dr. Hugh-Jones said the best indication of a bioterrorist event would be multiple cases. Even then, he said, a natural source could cause a cluster of cases.
Scientists hope to find the source of Mr. Stevens's anthrax by matching its DNA against a geographical catalog of strains maintained at the Los Alamos National Laboratory in New Mexico.
Dr. Jill Trewhella, head of the laboratory's bioscience division, said her laboratory had, for example, determined that an outbreak of anthrax among cattle a few years ago in Australia, where the disease had been unknown, came from India.
A study of import records showed that anthrax had occurred among cattle shipped from India in the 1850's. The carcasses had been buried but the spores survived 140 years until they were disturbed.
''This Florida case is a puzzle and one we will use all our tools to track down,'' Dr. Trewhella said.
Mr. Stevens arrived at the JFK Memorial Hospital emergency room in West Palm Beach, unable to speak, a hospital spokeswoman said. Family members told the staff physicians that he was disoriented, had a high fever and was vomiting, she said.
Mr. Stevens was treated with antibiotics, said Dr. Jeane Malecki, director of the Palm Beach County Health Department, but his health declined within hours of his admittance to the hospital.