Prescriptions
Risk of serious illness from anthrax low
By Landis Lum
With anthrax scares here in Honolulu the last few weeks, and several deaths on the Mainland confirmed to have been caused by anthrax, people everywhere are worried. How concerned should we be about being personally affected by biological and chemical terrorism? My next two columns (which appear monthly, as I rotate with other Prescriptions columnists) will explore this question and shed light on the various agents likely to be used by terrorists, as well as their treatments.
Some people have speculated that the plague germ could be used as an agent, but it degrades within hours of sun exposure. In contrast, anthrax spores are hardy — resistant to sunlight, heat and many disinfectants. In fact, in 1937 in Hawai'i, a cow contracted anthrax after disturbing a burial mound containing the remains of cattle that died in a 1917 outbreak of anthrax. Dried or processed skins and hides of infected animals (cattle, camels, goats, sheep and swine) may harbor the spores for years.
Anthrax is caused by a germ called Bacillus anthracis, and causes disease mainly in herbivorous mammals, which mainly get infected from spores in the soil. In humans, it is a risk for workers who process hides, hair, bone products and wool, as well as those who handle infected animals.
What are the symptoms of anthrax? About 95 percent of anthrax cases in developed countries are cutaneous (in the skin) and 5 percent are respiratory (in the lungs).
Anthrax spores deposited beneath the skin or in the lining of the lungs germinate after a delay of one to seven days (but this delay is sometimes 60 days for the lungs). The germs then multiply and produce a toxin.
In cutaneous anthrax, one would then notice an itchy bump which later turns into a larger, painless blister and then into an ulcer, frequently ringed by small blisters. By three to 10 days, a quarter-inch to one-inch black scab forms centrally. There may be tender lymph-node swelling and fever, malaise and headache. About 20 percent of cases are fatal, but deaths are rare after antibiotic treatment with cipro, doxy, or possibly amoxacillin or penicillin.
In contrast, respiratory or inhalation anthrax is fatal 90 percent of the time, even with antibiotics. It starts with one to three days of malaise, low-grade fever, dry cough and, sometimes, chest pressure.
After this, one rapidly becomes very sick, with shortness of breath, noisy breathing, rapid pulse, high fever, profuse sweating and sometimes gastrointestinal bleeding.
Fortunately, experts feel that the chance of a wide-ranging, successful bioterrorism attack leading to widespread respiratory anthrax and multiple fatalities is very low.
First, producing "weapons-grade" anthrax requires considerable expertise. Not all strains of anthrax (or plague) are equally deadly. Growing the right strains in the lab and keeping them pure and virulent is tricky.
As for the risk of a mass attack, not many people have the technical expertise to deliver these germs or spores in large amounts as the tiny aerosol particles necessary to penetrate deeply into the lungs (rather than merely get caught in the nasal passages as with most of the exposed people in the recent news). Crop dusters are designed to deliver pesticides in heavy streams of 100 microns, not the fine mist of 1 to 5 microns necessary to spread "weapon's- grade" anthrax. You may recall that the Japanese cult Aum Shinrikyo (which managed to kill 12 people in a 1995 Sarin nerve-gas attack in a subway) tried spraying anthrax and botulism eight times in Tokyo without effect.
The risk of anthrax showing up in your mail is exceedingly small, but if you do get suspicious envelopes or packages, don't open, touch, smell or shake them — just notify the police.
In summary, your risk of getting seriously ill from anthrax is low. Furthermore, anthrax is not contagious. Therefore, don't bother stocking up on antibiotics or gas masks. You are far more likely to get an allergic reaction to that antibiotic than prevent a bonafide anthrax illness, in which case you will never be able to use that antibiotic again in the future when you may really need it.
Dr. Landis Lum is a family practice physician with Kaiser Permanente, and an associate clinical professor of family and community medicine at the University of Hawai'i's John A. Burns School of Medicine.
Hawai'i experts in traditional medicine, naturopathic medicine, diet and exercise take turns writing the Prescriptions column. Send your questions to: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column is not intended to provide medical advice; you should consult your doctor.
