INFANT'S ANTHRAX ENTERS JOURNAL 



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Last Updated

11 Jun 2003

Source: USA Today, November 8, 2001.

Infant's anthrax enters journal

By Steve Sternberg, USA TODAY

At first, doctors thought the ugly sore on the 7-month-old boy's arm was a spider bite (case 8). "That was before the first New York anthrax case was known," says Mary Wu Chang, a New York University pediatrician who treated the infant after he was admitted to the hospital on Oct. 1. Then came disturbing news -- Tom Brokaw's assistant at NBC News had anthrax (case 2). The terror-by-mail anthrax crisis, still unfolding in Florida, had reached New York. Even more disturbing, the infant's mother worked for ABC News, prompting her to wonder: Could her son have anthrax, too?

His positive diagnosis would add a new twist to the flurry of anthrax-laced mailings that by then had killed one man -- a case in an infant who was exposed to anthrax in a place where no anthrax could be found. Such diagnoses are so rare that the New England Journal of Medicine today released an article on anthrax care with an image of the boy's lesion to help other doctors recognize the disease.

The Brokaw story broke on a Friday afternoon [October 12, 2001]. By evening, epidemiologists from the Centers for Disease Control and Prevention had examined the child at New York University Hospital. They advised his doctors to send bits of tissue from the boy's wound to CDC's lab in Atlanta for diagnostic testing.

The results came in Monday [October 15, 2001]. They absolved spiders of a role in the boy's illness. Instead, he had cutaneous anthrax -- anthrax of the skin -- a disease usually confined to wool sorters and slaughterhouse workers. Chang says the boy's mother was "stunned" at the diagnosis. "This whole idea of bioterror became so real."

Initially, the boy's doctors hadn't considered anthrax. Why should they? Chang asks. "In the whole country, there'd be very few doctors who've seen anthrax," she says. "It's just so rare, unless you're in a place with infected cattle. This was Manhattan."

But the clinical picture fit. The boy's arm was swollen from his shoulder to his hand. The sore on his elbow wept a sticky yellow fluid made of proteins digested by anthrax toxin. Angry and ugly as it was, doctors say, the wound didn't hurt, which is typical of anthrax. "It looks terrible, but it's painless," Chang says. "He didn't feel 100%, but he would play and interact as if he wasn't really ill."

Fortunately, his pediatricians had started the boy on antibiotics five days earlier, when he was admitted to the hospital. By the time CDC returned the correct diagnosis, the boy was ready to go home.

Doctors decided to submit images of the boy's lesion to the journal, so colleagues could see what skin anthrax looks like and diagnose it early. Due "to public health concerns," the journal released the article before its Nov. 29 publication date.

Morton Swartz of Massachusetts General Hospital notes in the same medical journal that cutaneous anthrax takes hold when spores enter a cut in the skin. Within a week, a blister develops. Eventually, the skin over the blister dies, capping the ulcer with a crusty black lid called an eschar. With treatment, skin anthrax is 100% curable. Without treatment, 20% of its victims die. In people who recover, Swartz says, "the eschar falls off after one or two weeks with little ultimate scarring."