Anthrax baby first treated for spider bite
Wed Nov 07 2001 11:25:49 ET BOSTON (UPI -- The case of a 7-month-old child brought into a New York hospital with what appeared to be a spider bite, but actually was anthrax, is part of a New England Journal of Medicine report issued Tuesday that also includes an update on recognition and treatment of the infection.
The baby, son of an ABC TV employee in New York, had a nasty looking wound on his arm and doctors immediately started antibiotic treatment because they feared he had suffered a bite from a Brown Recluse spider.
However, when Dr. Kevin Roche of New York University School of Medicine heard about other anthrax cases at media outlets in New York, he performed a biopsy on the child's arm.
The tests confirmed skin or cutaneous anthrax infection, apparently contracted when the boy visited his mother's office at ABC. He became the youngest victim of the nationwide anthrax attacks.
"We had already been treating the child with antibiotics," Dr. MaryWu Chang, assistant professor of dermatology and pediatrics at NYU, told United Press International. "And he was doing much, much better by the time we found out it was anthrax."
The report on the case, along with pictures showing the extent of the child's injury, are to be found in the Nov. 29 issue of the New England Journal of Medicine but were released early because of the national attention on anthrax. The journal also released an update on the recognition and management of anthrax, written by Dr. Morton Swartz of the Massachusetts General Hospital.
"We are releasing these articles early because of their potential public health importance," Dr. Jeffrey Drazen, editor-in-chief of the Boston-based journal, said in a statement to subscribers.
In the brief description of the case, Roche, assistant professor of clinical radiology at NYU, said the infant was brought into the hospital with a two-day history of swelling of the left arm and a weeping, open sore about 1 inch in diameter.
"The working diagnosis was Loxosceles reclusa spider bite," Roche reported.
Bites from the Brown Recluse spider, also known as the violin spider because of its markings, can be fatal. The venom kills cells surrounding a bite, producing a black gangrenous spot -- similar to skin anthrax. However, the spider is not usually found in northern climates.
"A Brown Recluse spider bite is very rare in New York City," Chang said, "but at the time anthrax certainly was a whole lot rarer."
She said the boy was treated for about two weeks, although he was discharged from the hospital only a couple of days after the anthrax diagnosis was confirmed.
The doctors noted the child visited his mother's office, where she worked as a television show producer, three days before admission. That visit was about two weeks after the destruction of the World Trade Center on Sept. 11.
Chang said when the doctors suspected anthrax, the Centers for Disease Control and Prevention in Atlanta was notified and specimens were rushed to the lab there, which confirmed anthrax infection about 48 hours later.
In the second article, Swartz, professor of medicine at Harvard Medical School, reviewed the current anthrax attacks, noting use of anthrax as a weapon has been considered since at least 1979, following an anthrax outbreak at a Soviet Union bioweapons facility.
He said treatment of anthrax in the current situation should begin with ciprofloxacin (Cipro) or doxycycline until it can be determined the anthrax strain is susceptible to penicillin. Then, he said, amoxicillin could be used to treat exposed individuals, but added amoxicillin or penicillin should not be used as a single treatment because anthrax appears to be able to develop a form of resistance to penicillin.
Swartz said because of the danger of weapons grade anthrax, he would treat even pregnant women with Cipro. Most doctors would refrain from prescribing Cipro-like drugs -- fluoroquinolones -- during pregnancy.
He cautioned the use of Cipro and doxycycline in children can have adverse effects "and these must be weighed carefully against the risk of life-threatening anthrax infection." Swartz said people being treated for anthrax exposure should stay on medication for 60 days. "The goal of the article was to bring the general practitioner up to speed in dealing with anthrax, a disease that had virtually disappeared from the screen until these events," he told UPI.
(Written by Ed Susman in West Palm Beach, Fla.) |
