NCJ Number
191690
Journal
Journal of American Medical Association Volume: 286 Issue: 17 Dated: November 7, 2001 Pages: 2086-2090
Date Published
2001
Length
5 pages
Annotation
This report updates the cases of anthrax being reported in the United States in the fall of 2001.
Abstract
On October 2, health officials in Florida were notified of a possible case of anthrax in Palm Beach County. The state laboratory and the Centers for Disease Control (CDC) confirmed the case of inhalational anthrax on October 4. The patient was a 63-year-old male. Despite antibiotic therapy, he died October 5. On October 1, a second patient, a 73-year-old co-worker of the first patient, was admitted to a hospital for pneumonia. His case was confirmed and he was kept in the hospital for therapy. Investigations revealed anthrax at the work site. One thousand seventy-five nasal swabs were taken from employees, and one resulted in the finding of Bacillus anthracis, the pathogen that causes anthrax. Table 1 shows recommendations for treatment of people who have inhaled the bacteria. Box 1 describes the clinical forms of the three kinds of anthrax: inhalational, cutaneous and gastrointestinal. On October 16, two cases of cutaneous anthrax were confirmed in New York City. In one case, a 38-year-old woman developed symptoms after handling a letter containing B. anthracis. The other case involved a seven-month-old infant who developed symptoms after visiting his mother's workplace. No suspicious letter with powder was identified at the workplace. Both patients were treated with ciprofloxacin and are improving. Three other people who handled the suspicious letter were exposed to anthrax. Editorial note: The findings in the report indicate that four confirmed cases of anthrax have resulted from intentional contamination of letters. Laboratories should suspect anthrax when patients have a rapidly developing respiratory illness or a cutaneous ulcer. If suspected, laboratories should notify state public health officials. After the September 11 terrorist attacks, CDC recommended heightened surveillance for illness patterns and diagnostic clues. Health care providers should be on the lookout for similar illnesses concentrated in the same area, an unusual age distribution for common diseases, and a large number of acute cases of flaccid paralysis, suggesting a release of botulinum toxin. The paper provides symptoms for outbreaks of anthrax, plague, botulism, smallpox, inhalational tularemia, and hemorrhagic fever. A laboratory should try to characterize bacilli. If it cannot do so, the lab should send the sample to a state health laboratory. Infection control professionals should work to ensure hospitals are prepared to deal with the outbreak. Health departments should educate workers about how to recognize unusual illnesses. References