Florida Man Dies of Rare Form of Anthrax
By DANA CANEDY with NICHOLAS WADE [NYT]
LANTANA, Fla., Oct. 5 — A 63- year-old Florida man who had
been hospitalized with pulmonary anthrax on Tuesday died today, state
health officials said.
Officials from the federal Centers for Disease Control and Prevention said
the case seemed to have been an isolated one with natural causes. Still, as a
now-routine precaution during a time of extreme concern, they are
considering the possibility it was the result of a terrorist act.
"I don't think we want to give anyone the idea that we have even the slightest
inkling of an idea what could have caused this disease," said Dr. Steven
Wiersma, an epidemiologist with the state health department. "We have a
team of 50 people — state, local, federal health department officials, as well
as C.D.C. — in Lantana working on the investigation."
Though anthrax cannot be passed from one person to another, a coworker
of the man who died, Robert Stevens, a photo editor at the supermarket
tabloid Sun who inhaled the spores, has been hospitalized and is being tested
for the disease.
"The symptoms we are seeing are not those typical of inhalation anthrax," Dr.
Jeffrey P. Koplan, director of the federal disease agency, said of Mr.
Stevens's co-worker, "but, nevertheless, we have a variety of tests we are
processing to make sure it is not anthrax."
Investigators have examined the charts of more than 100 patients in area
hospitals with severe infections, but they said they had found no other cases
of anthrax.
They are also testing and monitoring Mr. Stevens's wife, relatives and anyone
else who had recent and regular contact with him. So far, the authorities said,
there were no indications that any of those people had been infected.
Officials said that Mr. Stevens went to North Carolina to visit his daughter
and her boyfriend on Sept. 28 and returned home a couple of days later.
Health officials in North Carolina are helping in the investigation, in which
epidemiologists are tracing Mr. Stevens's activities for the past 60 days.
Today, a team of specialists searched his one-story, ranch-style house here,
which was surrounded by crime-scene tape. They took samples of dirt from
the backyard where Mr. Stevens tended a garden to test for bacterial spores
which can persist in soil for years. Investigators also took fertilizer sprays and
pesticide bottles from the house.
Agents of the Federal Bureau of Investigation were at the house as the
scientists collected evidence, though a spokeswoman for the bureau said
investigators were conducting a public health probe, not a criminal one.
"We're out there following them just in case anything is found," Judy
Orihuela, the spokeswoman, said.
Officials have also enlisted the aid of local veterinarians to try to determine if
animals in the area are infected with the disease.
Dr. Martin Hugh-Jones, an anthrax expert at Louisiana State University, said
he strongly doubted a suggestion that Tommy G. Thompson, the secretary of
health and human services, made on Thursday that Mr. Stevens had caught
anthrax from spores on his clothes or drinking water from a creek.
Anthrax is widespread in the western United States but has not been found
east of the Mississippi in decades, Dr. Hugh-Jones said.
Still, anthrax can live in the soil for decades and could persist in Florida, even
though the last known case there was 28 years ago, Dr. Koplan said. The
spores, which are release by the bacteria, can also be carried in bone meal,
which is often used as a fertilizer.
Even so, the spores are quickly killed in sunlight, one reason it is hard to
explain the oddest feature of the Stevens case. More than 95 percent of
anthrax cases are contracted through the skin, often by people who have
handled infected animals or their hides.
But pulmonary cases, like Mr. Stevens's, require inhaling a large dose —
8,000 to 10,000 spores — usually in enclosed spaces protected from direct
sunlight, like bone meal production plants, wool factories or laboratories
where the bacteria is studied.
Only 18 cases of pulmonary anthrax have been reported in the United States
in the last 100 years, 2 of which involved laboratory workers.
Because the disease's incubation period varies from one to 60 days, Dr.
Koplan said officials at the Centers for Disease Control were "paying great
attention to every place" Mr. Stevens had been in the two months before
developing it. Still, he added, "last I heard, I was not aware of visits to such
places."
Dr. Koplan said that the center was screening the region for other cases of
anthrax, considering anyone who has anthraxlike symptoms or who received
a blood test or lumbar puncture.
He said that it was now the C.D.C.'s routine policy not to rule out terrorism
but that no reason had yet been presented to suggest that Mr. Stevens's case
had an other-than- natural cause.
Dr. Hugh-Jones said the best indication of a bioterrorist event would be
multiple cases. Even then, he said, a natural source could cause a cluster of
cases.
Scientists hope to find the source of Mr. Stevens's anthrax by matching its
DNA against a geographical catalog of strains maintained at the Los Alamos
National Laboratory in New Mexico.
Dr. Jill Trewhella, head of the laboratory's bioscience division, said her
laboratory had, for example, determined that an outbreak of anthrax among
cattle a few years ago in Australia, where the disease had been unknown,
came from India.
A study of import records showed that anthrax had occurred among cattle
shipped from India in the 1850's. The carcasses had been buried but the
spores survived 140 years until they were disturbed.
"This Florida case is a puzzle and one we will use all our tools to track
down," Dr. Trewhella said.
Mr. Stevens arrived at the JFK Memorial Hospital emergency room in West
Palm Beach, unable to speak, a hospital spokeswoman said. Family
members told the staff physicians that he was disoriented, had a high fever
and was vomiting, she said.
Mr. Stevens was treated with antibiotics, said Dr. Jeane Malecki, director of
the Palm Beach County Health Department, but his health declined within
hours of his admittance to the hospital. |
