With no clear source of the bacteria identified, fears of possible exposure have prompted dozens of evacuations, hundreds of tests and thousands of antibiotics prescriptions across the United States. With flu season just around the corner, doctors are bracing for a wave of anxious patients wondering whether they have influenza or anthrax. NEWSWEEK’s Jennifer Barrett spoke with Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, about how the anthrax scare.
NEWSWEEK: How does someone distinguish between what are merely flu symptoms and what may be the early stages of anthrax?
Dr. Anthony Fauci: In the early stages of influenza and of anthrax, there are considerable similarities, so there is no absolute way to distinguish between them in the early stages of the disease. There are some tests, flu kits, but I wouldn’t put great stock in that being the major component in my differential diagnosis. If something progresses rapidly, there’s a good chance it’s something else, not the flu. But there are a variety of other infections that would give similar symptoms.
In the situation of anthrax versus flu, the history and the circumstances surrounding the person–where they were, what they do–would take on a much heavier weight in trying to distinguish between the flu and anthrax in the early stages. Now there are some patterns associated with the cases of anthrax–most are directly or indirectly connected with the Postal Service … If you have a businessman in Iowa or a construction worker in Texas with flu symptoms, my index of suspicion would be much lower than with someone who walked into my office in Washington, D.C., who worked in a post office down the street and said he had symptoms of the flu.
What should the public know about anthrax?
There is cutaneous [skin] anthrax which is imminently more treatable than the other form, which is inhalation anthrax. Cutaneous anthrax has been well described in the media as a lesion on the skin that looks like a little pimple then swells up, soon becomes a pustule and then ulcerates with a black scab that is very characteristic of anthrax. That takes place over several days to a week, and the patient feels systematically worse. The time frame is measured over days so if they are alert enough, and their doctor is alert enough, there’s enough time to treat the anthrax with antibiotics. In contrast, inhalation anthrax presents with some vague symptoms that progressively accelerate … From the descriptions of inhalation anthrax cases in New York, D.C. and Florida, the people presented similar symptoms: headache, nausea, muscle aches, fever and feeling washed out. Then they progressively developed a very debilitating syndrome, shortness of breath, difficulty breathing, pulmonary and other involvement.
The toxicities vary between the two. Ciprofloxacin has some cardiovascular effects, palpitations and cardiac arithmeas. It can affect the central nervous system–insomnia, irritability, some depression, psychiatric manifestations, gastrointestinal problems, secondary infections. They’re not common effects but they do occur. About 7 percent of patients develop a toxicity that is directly related to the drug, and about 3 percent have to discontinue using it because of the side effects. Doxycycline in general has less severe toxicities but it can have skin reactions, photosensitivity and other hypersensitivity reactions. All antibiotics have some toxicities.
If you’ve been exposed to anthrax, how long should you take the antibiotic?
If you’ve clearly been exposed, you should be treated for 60 days with either ciprofloxacin or doxycycline. In studies in which animals were treated for 30 days, in some animals up to 40 days after they stopped taking the antibiotics, some had re-exacerbation of the anthrax. In order to be doubly safe, you should take it for 60 days.
There is some concern that many people are taking the antibiotics out of fear and that widespread use of the antibiotics could actually fuel the growth of drug-resistant strains of other, more dangerous and possibly contagious bacteria. In your opinion, how much of a risk is there of this occurring?
That is a distinct possibility, which is a reason why you should be serious about your decision to take antibiotics. If you need it, if you truly are exposed, then no problem. Some people get nervous and want to be on it even when they have no documented risk. But if there is not a documented risk, it is not prudent to take antibiotics because the potential toxicities to you as well as the possibility of selecting for resistant microbes is such that the risk versus the benefit clearly does not indicate you should be on antibiotics.
The New York hospital worker who died this week from inhalation anthrax did not appear to contract the inhalation anthrax from touching tainted mail as other victims did. What does the latest case tell us about the bacteria?
That remains a mystery that really needs to be thoroughly investigated. The only way to figure it out is to do an intensive epidemiological investigation to try and track down what the source of it is.
What kind of steps can we take as individuals and as a country?
Just vigilance, because we don’t know how this latest case originated. There is not enough anthrax vaccine right now to vaccinate everyone in the country. If there was enough in the future, you would have to balance that against what the persistent risk of anthrax is. If this is one perpetrator who’s a mad-bomber type, and you apprehend him and put him out of business, then the risk is gone. But it’s a different story if this is truly part of a bioterrorism network.
