Case 22 CONFIRMED
The patient worked in the stockroom of
Manhattan Eye, Ear and Throat Hospital.
She was a Vietnamese immigrant who lived alone, had no family and few
friends who knew her activities. The patient became ill on October 25 with
malaise and myalgias. During the next several days, she had shortness of
breath, chest discomfort, and a productive cough with blood-tinged sputum.
She reported no fever, chills, or night sweats. She presented to an
emergency department on October 28 in respiratory distress. Her temperature
was 102 F (39 C), and she was admitted to the intensive care unit and
required mechanical ventilation. Initial chest radiograph revealed pulmonary
venous congestion and bilateral pleural effusions; a chest computerized
tomography (CT) scan revealed a widened mediastinum and bilateral pleural
effusions. An echocardiogram indicated a small pericardial effusion. She was
empirically treated with levofloxacin, rifampin, and clindamycin. Blood
cultures grew B. anthracis less than 24 hours after admission. Her
pleural effusion revealed hemorrhagic fluid and B. anthracis. The
patient died on October 31.
Click for clinical details (Emerging Inf Diseases) (11-12/01)
Click for complete clinical details (JAMA) (2/20/02)
Click for additional roentgenographic details (Am J Roentgenology) (5/02)
Click for gross pathology findings (Arch Pathol Lab Med) (8/02, PDF
file)
Click for news account of Kathy Nguyen (11/11/01)
Click for news account of enigmatic case (11/19/01)
Click for news account of new FBI investigation team (11/28/01)
Click for news account of possible cross-contamination (12/3/01)
Click for news account of probable cross-contamination with Leahy letter (12/4/01)
Click for news account of negative tests near her home (12/5/01)
Click for news account of treatment (2/20/02)
Click for CDC summary of possible exposure analysis (4/2/02)
Click for cross-contamination theory of 10-100 spores (5/14/02)