My medical practice is in Washington, D.C., where I see many patients who have symptoms that could be attributed to anthrax. I do not believe that the terrorists can cause an epidemic of anthrax, but they can cause some people to get very sick. Don't panic because we have had only a few deaths, and fewer than 20 people are known to have become sick from anthrax. That's out of more than 280 million Americans. So your chances of getting anthrax are very small.
However, many people are terrified that any symptoms that they get are caused by anthrax. Inhaled anthrax often starts as flu-like symptoms: headaches, muscle aches, cough, fever, chills, perhaps vomiting. Then from hours to days later, it enters your lungs, where you cough and become short of breath, you sweat profusely and can go into shock and die.
If you suspect that you have been exposed to anthrax, you should go to your doctor immediately. Blood antibody tests do not show evidence of infection until at least two weeks later. Blood and nasal cultures can grow out the germ, but they have to be sent off to a commercial lab. The only quick way that a doctor can diagnose anthrax is to stick a Q tip in your nose and immediately rub it on slide and look for spores under a microscope. Since most doctors do not know how to look for anthrax spores, they will prescribe far more antibiotics than they usually do.
Any quinolone antibiotic such as Cipro, Levaquin or Avalox will be effective but they are very expensive and can cause horrible muscle pain. I am sure that future reports will show that penicillin and doxycycline are just as effective as Cipro, and they are far less expensive. We were concerned that the Russians could have engineered a type of anthrax that is resistant to doxycycline, but the strains of anthrax that have occurred so far in the United States are susceptible to doxycycline. Unlike Cipro, doxycycline is cheap and does not cause terrible muscle and tendon pain and tendon ruptures during exercise.
Nobody knows how long you have to be treated with antibiotics for anthrax. Currently many doctors recommend eight weeks, because the antibiotics kill the active infecting bacteria, but they do not kill the resting spores. I believe that future reports will tell us to prescribe antibiotics for about three weeks, but that is just a guess and it may be that some people will have to take antibiotics for many months or until they are immunized against anthrax.
I think that the terrorists are the most likely cause of these cases. We have had only 18 cases of inhaled anthrax reported in the United States since 1900. A goat hair processing plant in Manchester N.H. had 136 cases of skin anthrax cases over 16 years. And not one developed inhaled anthrax until 1957 when 4 out of 6 people infected died from it. So we already have more cases of inhaled anthrax than we have had reported ever in the United States.
On October 5, Robert Stephens, a 63-year-old newspaper photographer, died of anthrax in Florida. He was hospitalized four days before when he checked himself into JFK Medical Center in Boca Raton. Now a person who worked in the same building of the Boca Raton Sun newspaper has tested positive for this rare and deadly disease, forcing health officials to immediately shut down the Boca Raton offices of the Sun and its sister publications. Environmental tests detected the anthrax bacteria in the building.
Within seven days after inhaling the spores of anthrax, a person develops cold-like symptoms to severe breathing problems and shock, nausea, vomiting, diarrhea, and then starts to vomit blood. Death can occur within 24 hours of onset. You can get anthrax from infected animals by eating infected meat or by getting the anthrax spores into your skin through a cut. However, these methods are not the concern in germ warfare. We are terrified about breathing anthrax into your lungs, which is almost always fatal. You cannot get anthrax from another person. We have not had a case of anthrax in the United States for 25 years. Now we have two cases and both are from the same building, and they have already found anthrax spores in that building.
Anthrax is a naturally occurring disease of plant eating animals (goats, sheep, cattle, swine, etc.) caused by the bacterium Bacillus anthracis. In 1940, Britain experimented with using anthrax for germ warfare. They infected Gruinard Island, off the coast of Scotland, and today it still remains infected with anthrax , more than 60 years later.
Symptoms: About 1-6 days after inhaling Bacillus anthracis spores, you would suffer fatigue, fever, mild discomfort in the chest and a possibly a dry cough. You would feel better for a few hours or 2-3 days. Then, you would become short of breath, sweat heavily, turn blue and then go into shock and die in 24-36 hours. You may be able to protect yourself by being immunized at least 4 times before exposure, and then onc e a year, but it may not work for inhaled anthrax. Otherwise, if you are exposed, you have to take penicillin immediately and stay on it indefinitely. And while you take penicillin, you have to be immunized. If you are allergic to penicillin, you can take doxycycline or Cipro.
It is extremely difficult to use anthrax for germ warfare. First of all, it is very difficult to cause the bacterium to make the spores that have to be inhaled. Second, there are two type of anthrax spore powder: wet and dry. Only the dry type can travel far and wide and infect many people, and it is extremely difficult to make and keep the dry anthrax spores. Crop dusters and other sprayers produce large droplets that fall to the ground. For germ warfare, anthrax has to be sprayed through a special nozzle that sprays small particles that remain in the air, and this is very hard to do. The crazy Aum Shinrikyo cult in Japan had anthrax and sprayed it on people in a city, but didn't kill anyone because they did not have the dry spores and because they were unable to make a nozzle that sprayed small enough droplets to remain in the air.
I do not believe that the terrorists have any technique to cause epidemics of anthrax. However, I do believe that they could have small vials that they can put in air conditioning systems. Fortunately, the spores from anthrax are very large. They are between ½ to 1 milimicrons that can be caught in electrostatic filters and perhaps even the hepa filters that have very small pores. So we probably can protect ourselves by installing electrostatic filters in heating and air conditioning systems, and being careful about who has access to building systems.
Side effects from anthrax vaccine: 1-5% have sore arm 5-30% have muscle aches, headache, fever (benign) 1/50,000 hospitalized 1/100,000 have serious, life threatening allergic reaction People who should not get the vaccine: those with an autoimmune disease, low immunity as in HIV, acute respiratory disease, or on immunosuppressives.
Reported 10/27/07; checked 8/9/05
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