Clinical Center Communications
Colleen Henrichsen, 301-496-2563
Anthrax Findings Presented by NIH Researcher
"These results are presented in an effort to make doctors aware of
what to look for when diagnosing suspected anthrax patients," said Dr.
Luciana Borio, lead author of the paper. Borio, who is fellow in the Critical
Care Medicine Department of the NIH Clinical Center and researcher at the
Johns Hopkins Center for Civilian Biodefense Studies, published the findings
in collaboration with physicians at the Greater Southeast and Southern Maryland
Hospitals, and the DC and Maryland Medical Examiners Office. An accompanying
editorial by Anthony S. Fauci, MD, Director of the National Institute of Allergy
and Infectious Diseases (NIAID) and H. Clifford Lane, MD, NIAID Clinical Director,
is also posted on the JAMA website.
Because the symptoms in these two cases were nonspecific, they were initially
misidentified as flu or other common infections. However, a later review of
the laboratory data showed pathology different from common infections, according
to Borio. Both patients' blood tests showed increased white blood-cell counts
and concentrated red blood-cell counts. Neither finding would normally be
seen in flu patients, said Borio. In addition, blood cultures quickly showed
long chains of the distinctive anthrax bacilli.
"Laboratory tests should be ordered if there is any suspicion of anthrax,"
Borio stressed. "Both cases show the importance of testing by microbiology
laboratories with staff experienced in growing and identifying these unusual
Both postal workers also developed fluid build up in the chest and infiltrates
in the lungs that resembled pneumonia on radiologic images. "It would
have been easy to misdiagnose these cases as pneumonia, and thus rule out
anthrax, if doctors had relied on the x-rays alone," said Borio.
"It's essential that doctors are familiar with how anthrax presents
in order to distinguish it from more common infections," said Borio.
"Both patients were sick enough to seek medical help," she said,
"but neither had symptoms that would normally require further tests or
hospitalization, so they were initially sent home."
The two anthrax victims were among five postal workers who worked at the
Brentwood postal facility in Washington who contracted anthrax in October.
One had gastrointestinal symptoms, including nausea, vomiting and stomach
pain. The other had flu-like symptoms, including muscle ache, discomfort and
fatigue. Both developed chest pain and breathing difficulty, eventually requiring
Doctors made a working diagnosis of anthrax after the media reported two
other postal workers from the same facility were diagnosed with anthrax. Although
both were treated with antibiotics, both died within 24 hours of hospitalization.
"Without warning that anthrax was present in the community, doctors
would be unlikely to consider such a rare conditon," said Dr. Henry Masur,
chief of critical care medicine at the NIH Clinical Center. "The analysis
and prompt publication of these findings will help doctors avoid such tragic
consequences in the future."
Other authors contributing to this study were Dennis Frank, MD; Venkat Mani,
MD; Carlos Chiriboga, MD; Michael Pollanen, MD, PhD; Mary Ripple, MD; Syed
Ali, MD; Constance DiAngelo, MD, MS; Jacqueline Lee, MD; Jonathan Arden, MD;
Jack Titus, MD; David Fowler, MD; Tara O'Toole, MD, MPH; John Bartlett, MD;
and Thomas Inglesby, MD.
The Warren Grant Magnuson Clinical Center is a component of the National
Institutes of Health (NIH).The Clinical Center is the clinical research hospital
for NIH. Through clinical research, physicians and scientists translate laboratory
discoveries into better treatments, therapies and interventions to improve
the nation's health.