ILL POSTAL WORKER HAS SYMPTOMS NOT-ANTHRAX
30 Nov 2002
Source: New York Times, January 11, 2002.
Ill Postal Worker Has Symptoms That Stop Short of Anthrax
By SHERYL GAY STOLBERG
37-year-old postal inspector who cleaned equipment contaminated with anthrax spores at the Brentwood postal center in Washington has been seriously ill for nearly three months with symptoms that strongly resemble inhalation anthrax, the deadliest form of the disease.
But there is no evidence of anthrax bacteria in his blood, and his chest X- ray does not show one characteristic sign of anthrax. As a result, the Centers for Disease Control and Prevention has concluded that the inspector does not have the disease.
The perplexing case became public this week when it was reported in The Journal of the American Osteopathic Association and The Baltimore Sun. It is another curious twist in the anthrax investigation, which has confounded medical experts from the start.
"It's a mystery," said Dr. Gary J. Kerkvliet, an internist who cared for the patient at Sinai Hospital in Baltimore. "This guy had a phenomenal exposure to anthrax, and temporally related to that, his whole life changed. We don't have any evidence that he has anthrax. But neither have we found any other explanation for these symptoms."
The man was previously healthy, and athletic, his doctors said. Tests have ruled out fungal infections, viral infections, autoimmune disease and other possible explanations for his symptoms, which have included high fever, severe shortness of breath and low oxygen in the blood.
The inspector, who said through Dr. Kerkvliet that he did not want to be interviewed, was recently released from the hospital after having spent 45 days there receiving intravenous antibiotics. He is recuperating at home, but is still too ill to return to work. Although his doctors declined to give the man's name, The Sun identified him as William R. Paliscak Jr. of Edgewater, Md.
Mr. Paliscak's encounter with anthrax spores occurred days after Oct. 15, when an anthrax-contaminated letter was opened in the office of Senator Tom Daschle, the Democratic leader. As a postal inspector, Mr. Paliscak was assigned to evaluate the letter-sorting machine at the Brentwood center through which the Daschle letter passed.
Dr. Tyler Cymet, who also treated Mr. Paliscak at Sinai Hospital, said the inspector had handled at least one highly contaminated air filter. The article in the journal said he had inspected "about 10 packages at high risk for containing anthrax."
Three days after the inspection, Mr. Paliscak was given a 10-day course of the antibiotic Cipro, as a preventive measure. He took the drug for one day and then skipped an evening and a morning dose, his doctors said. Within days, he developed headaches and a cough. He was admitted to the hospital with what appeared to be a serious lung infection.
"This patient had a low oxygen level in his blood," Dr. Cymet said. "He had fluid in his lungs. He had severe chest pain. He had weakness. These are not things you can fake."
The doctors added two other antibiotics from other families to his regimen. In three or four days, Dr. Cymet said, he had improved enough to be released.
But within a week, Mr. Paliscak was back at the hospital, again weak and short of breath. His oxygen level had slipped, and X-rays showed enlarged lymph nodes in his lungs. But he did not have one characteristic that other patients exhibit, an enlarged mediastinum, the area in the center of the chest.
"The bottom line," said Kathy Harben, a spokeswoman for the Centers for Disease Control and Prevention, "is that the clinical findings did not suggest anthrax to the C.D.C. investigators."
But even if the man does not have anthrax, Dr. Kerkvliet said, his doctors believe that his exposure may be responsible for his symptoms. They are saving his blood in case tests are developed for some anthrax-related illness that has not yet been discovered.
"There may be something that we don't know about yet," Dr. Kerkvliet said, "some disease entity that has not yet been described."