TWO THINK PATIENT'S SYMPTOMS MAY BE MISSED ANTHRAX
20 Aug 2003
Source: Reuters, July 17, 2002.
Two Think Patient's Symptoms May Be Missed Anthrax
WASHINGTON (Reuters Health) - Two physicians in Baltimore write in the July issue of a medical journal that one of their patients who was exposed to anthrax continues to display symptoms even though the bacteria and its toxins haven't been found in his blood. Two people who died last fall from anthrax similarly tested negative for infection, they say.
Tyler Cymet, an osteopathic doctor and internist, and fellow internist Gary Kerkvliet, of Baltimore's Sinai Hospital, first wrote up their patient's case in the January issue of the Journal of the American Osteopathic Association. The patient is a 38-year-old US Postal Service investigator who spent time at the Brentwood office in Washington, DC, which received anthrax-contaminated mail destined for Congress.
Some correspondence to the Journal since January has doubted the doctors' contention that they may have found a previously undescribed syndrome related to anthrax exposure. In the July issue, the doctors defend their report, stating that the patient may have a lingering syndrome resulting from inadequate or unsuccessful treatment.
Little is known about anthrax, they said, noting that two Brentwood workers died from inhalational anthrax but did not have positive blood cultures, while two with positive cultures survived.
The Centers for Disease Control and Prevention (CDC) said it doubted the Baltimore man had ever been infected.
"We did extensive testing to try to rule in or rule out anthrax, and at the conclusion of all those tests, we are highly confident that this person isn't suffering from anthrax," said CDC spokesman Tom Skinner.
The postal inspector reported ingesting dust particles -- positive for anthrax -- from a sorting machine and air filters. The man had been given a 10-day preventive course of Cipro. After taking one pill, he missed two doses and immediately came down with a cough, headache, chest pain, and low oxygen levels.
He was admitted to the hospital and given IV antibiotics; symptoms improved and he was sent home. A blood culture tested negative for anthrax. The man was re-admitted to the hospital a month later, in November, for the same hacking cough, chest pain, and fluid in the lungs.
The previously healthy postal worker has spent 4 of the last 9 months at Sinai, fighting fluid build-up and inflammation in his lungs and around his heart, and has extreme fatigue and continued low oxygen, Cymet told Reuters Health.
The physicians are still trying to determine the cause of his illness.
"The working hypothesis right now -- and we're not sure -- is that he was exposed, he was partially treated with a day of antibiotics and that did give him some protection, but he still had some toxins that would have caused the symptoms," Cymet said.
He said that they are exploring the possibility that the bacteria or toxins are hiding in the man's body, most likely in the brain.
That theory was advanced in the May issue of the Journal by Lowell Wood, a fellow at Stanford's Hoover Institution and a member of the Lawrence Livermore National Laboratory's technical staff. Wood noted that most antibiotics used to treat anthrax do not cross into the brain, so the bacteria would be safe there.
Cymet and Kerkvliet are also seeking Sinai's permission to do a long-term study of the survivors of the anthrax attacks, including their patient, who they consider to be a survivor.
SOURCE: Journal of the American Osteopathic Association 2002;102:7.