Posted by Mitchell on October 27, 2001, at 1:43:00
In reply to Re: Could it be Anthrax? » bboal, posted by paxvox on October 26, 2001, at 16:48:44
I agree that the cutaneous lesion described here is probably not anthrax infection, primarily because the risk profile does not match that of recent antrhax infections. The secondary symptom described here is anxiety over what might have caused the lesion. In an uncertain and dangerous time, accurate information delivered in a calm and balanced voice has proven to be a reliable means to relieve some anxiety and to prevent panic. Medication should be considered only after other concerns are discussed with a patient.
>1 in 20 billion, that's your chance of getting an anthrax letter.
The present concern is not necessarily receipt of an anthrax letter, but rather possible infection from an unknown source, perhaps by secondary contamination such as the workplace exposure that resulted in the deaths of two U.S. postal workers. But the odds of receiving an anthrax letter, if one letter has been delivered anywhere in the world, could be about 1 in 6 billion (the estimated current world population)
Confirmed letters have been reported at a U.S. Senate office, and at two New York publications. With three confirmed letters, the odds would be about 1 in 2 billion.
Since all three letters letter were confirmed in the United States, the odds of receiving a letter would be about 1 in 100 million. If we narrow the group of likely recipients to U.S. residents in eastern states, the odds get even higher. But if we estimate that all of the confirmed letters were sent to national figures, the odds, based on recent events, could be significantly lowered. But then if we used curve fitting to account for emerging use of anthrax as a weapon, the odds would be much higher, and might show trends that are truly cause for concern. The Centers for Disease Control say it is highly unlikely that the Daschle letter was the only biological weapon delivered to Washington D.C. through the U.S. mail.
The primary risk now during this biological attack, however, is not receipt of an anthrax letter. As of Oct. 26, 13 confirmed cases of anthrax had resulted in three deaths. None of the decedents had received a confirmed anthrax letter. Two were employees of mail handling facilities. Anthrax spores have now been identified in mail handling facilities at several sites in at least three states, and in facilities related to the Supreme Court, the White House, the CIA, the House of Representatives and several news networks. Three victims of pulmonary anthrax infections remained hospitalized and another was recovering as an outpatient. Six other cases involving cutaneous anthrax infections were being treated with antibiotics.
Based on that information, the odds of getting an infection could be estimated at about 1 in 30 million. But again, several factors mitigate. Based on recent events, the odds of dying in a terrorist attack in the United States this year are about 1 in 50,000. That is certainly less chance than the 1 in 6,000 odds of dying in an automobile crash, but it represents a significant increase over even the most recent highest risk year, 1995, when the odds of death by terrorism in the United States were closer to one in 2 million. To begin an accurate statistical analysis, we would also need to consider curve fitting to assess the emerging risk. But accurate statistical analysis is probably impossible because we lack sufficient data about terrorists' capabilities or intentions.
Given these circumstances, and the symptoms described here, it is reasonable that a patient presenting an unidentified cutaneous lesion request of a physician that mucus swabbed from their nasal membranes be cultured on an agar plate and examined under a microscope.
In the face of an emerging threat, some people may effectively normalize the risk and find comfort by exploring the relatively low level of the threat compared to other risks. Others can find comfort in seeking scientific confirmation that they were not infected in a biological attack.
> If you are worried still, get the Cipro, take it for 10 days.
Bactericidal fluoroquinolones are not prescribed as a treatment for worry. If accurate information does not help to resolve worry, any of several anti-anxiety agents might be helpful. In treatment of cutaneous anthrax infection, a 60-day regimen of 500 mg ciprofloxacin bid has proven extremely effective. For pulmonary anthrax infections, intravenous ciprofloxacin has proven effective in some cases.
In late October, an estimated 10,000 U.S. residents were prescribed a 10-day regimen of ciprofloxacin as a prophylaxis while they awaited results of cultured nasal swabs. Prophylaxis is indicated in cases where a person is known to have been in an area where anthrax spores were identified. Preliminary anthrax tests of suspected substances can return results in a matter of hours and more precise tests can return results within 24 hours. Prophylaxis is not indicated in cases where a threatening communication has not led to a suspected substance, or where a suspected substance has not been identified as anthrax.
Medical testing for anthrax can be indicated even when no known source of infection is identified. Several of the 13 known cases of anthrax infection were identified through medical testing before any environmental tests identified a risk.
Unlike antimicrobial prophylaxis, mucus cultures do not involve risks to the patient, and present only nominal risks to the health system. The ready supply of agar plates is sufficient to immediately begin tests of a significant portion of the U.S. population, if such tests were indicated. Contraindications of widespread mucus culturing include a possible overload of testing laboratories, which could distract from other testing schedules. Conversely, when there is an emerging threat of biological warfare, a demand for increased testing capacity at medical laboratories can help promote surge capacity, which is sorely lacking in laboratories, pharmacies, hospitals and medical product manufacturing facilities.
When symptoms present that are suspected by a patient as possibly being anthrax infection, testing can contribute to the mental well-being of the patient. In cases where there are no presenting symptoms and no credible evidence of possible anthrax exposure, counseling and perhaps anti-anxiety medication are probably better approaches.
> Anthrax, in its aerosolized form, especially the high-grade strain in Daschel's office, will kill you in 3-4 days w/o treatment
Recent evidence suggests that contact with small diameter anthrax spores, possibly coated with bentonite to make them more buoyant, can cause cutaneous or pulminary infections or can cause no infection at all. The cutaneous lesion described here has been treated with antimicrobial agents for several days, which would likely reduce morbidity or delay mortality if the cause were anthrax. Whether it resulted from anthrax or another unknown pathogen, a change in treatment regime might be appropriate if treatments so far have not produced satisfactory results.
> waiting for the mud-slingers
Please see response at Psycho-Babble Administration.
http://www.dr-bob.org/babble/admin/20010718/msgs/2232.html
poster:Mitchell
thread:82142
URL: http://www.dr-bob.org/babble/20011025/msgs/82424.html