Last Updated

13 Feb 2003

Source: Detroit News, October 26, 2001.

Treating anthrax victim was difficult

by Daniel Q. Haney / Associated Press

Miami -- The elderly man's labored breathing and fever seemed nothing more exotic than a bad case of pneumonia. But then Dr. Carlos Omenaca got a troubling call.

It was the patient's boss at American Media Inc. A fellow employee had just been diagnosed with anthrax, he said, the deadly inhaled form of the disease.

Hardly a U.S. doctor alive had ever seen a case of inhaled anthrax. Could this be another one?

The patient was Ernesto Blanco (case 7), the 73-year-old mailroom worker, who in retrospect turned out to be the first person hospitalized in the anthrax attacks and the first to survive the inhaled form of the disease.

But on that day about three weeks ago, Omenaca, an infectious disease physician in Miami, knew only that he should add the standard antibiotic for anthrax -- Cipro -- and read up on the disease.

Blanco had arrived at Cedars Medical Center in Miami on Oct. 1, confused and feverish, his lungs so congested that he had trouble breathing. He was started on one of the class of antibiotics that includes doxycycline and similar medicines. But he did not seem to get better. So a couple of days later, Omenaca was brought in.

After the call about anthrax, Omenaca spent six hours reading. By 2 a.m., he had gone through textbooks, journals and the Internet, but he was even less sure about the diagnosis. The classic sign of anthrax is a widening of the space between the lungs. His patient did not have that.

But the hunch changed to near certainty over the next three days. Dangerous new symptoms convinced the doctor he was dealing with inhaled anthrax, even though the Centers for Disease Control and Prevention could not be certain of this for another two weeks. The antibiotics had already killed the bacteria, and several painstaking tests were needed to prove it had ever been there.

By the time he started on Cipro, Blanco's breathing had grown still more difficult. He required extremely high doses of oxygen. Then his heart became irregular. It raced to 180 beats per minute, and he was moved to intensive care.

Doctors removed fluid from his lungs. It was bloody, a possible sign of anthrax or other dangerous infection.

A nasal swab added another piece of circumstantial evidence. It showed anthrax spores in Blanco's nose.

Finally, the most ominous sign of all. Blanco's blood pressure crashed, sending him into shock.

"I was near death. I felt physically, and in my soul, that I was leaving this world," Blanco recalled Thursday in an interview with the Associated Press at his North Miami home.

Doctors labored to keep him alive with large amounts of fluids and vasopressors, drugs that boost blood pressure.

But that was the low point. Over the next week, Blanco began to rally, improving almost imperceptibly each day.

Finally, Blanco was better.

This past Tuesday, Omenaca sent him home with 10 more days worth of Cipro.

"Considering the circumstances, I feel good," Blanco said Thursday between intermittent bouts of coughing. "I had many difficult, difficult days in the hospital, but I'm here."