New York Times
October 23, 2001
In Some Circles Anthrax Falls to the B-List
By ABIGAIL ZUGER, M.D.
Even as New Yorkers flinched at every new mention of anthrax last week and
fought rising panic, the regular Monday meeting of the city's infectious disease
specialists unfolded more or less as usual.
True, there were two cases of anthrax in the city, possibly more. But there
was also a case of cholera here last spring. An unusual, near-fatal case of the
dire food poisoning known as listeriosis surfaced over the summer. A young
German man picked up a peculiar, disfiguring case of H.I.V. A businessman came
down with a bizarre fungal infection on the golf course. A Mexican deliveryman
almost died from inhaling a rare soil organism common in Central America.
Against the panorama of microbes that routinely wander through this city and
threaten its residents, the hypothetical threat of anthrax seemed to fade a
little.
For 30 years, the Monday afternoon infectious disease meeting has drawn
specialists from around the metropolitan area. Every week, doctors take turns
describing the most interesting, perplexing or alarming infections they have
seen.
Back in 1979 and 1980, when AIDS, still unnamed, was sending a trickle of
sick patients into New York hospitals with puzzling symptoms, it was the
overview at this weekly meeting that gave city doctors a vision of a new and
frightening pattern of illness well before the rest of the country caught on.
Last Monday, the anthrax scare created exactly the opposite situation: the
name of a disease was resonating through the city, but the regulars at the
meeting had no actual cases to discuss. The single case of cutaneous anthrax to
have been identified here at that point had been treated for two weeks and the
patient was doing well. Any other cases were still hypothetical.
"We thought the collective wisdom of this group could be extremely
useful to the city at this point," said Dr. Stephen Baum, head of medicine
at Beth Israel Medical Center, president of the Infectious Disease Society of
New York and a member of the mayor's task force on bioterrorism. Dr. Baum took
the podium at the start of the meeting for a brief brainstorming session about
anthrax.
Not one of the 150 doctors in the auditorium was seriously worried that a
tide of infection was about to drown the city. Anthrax, which is not transmitted
from person to person and is treatable with antibiotics, is not a scary organism
in these particular circles. It is not nearly as frightening and potentially
dangerous as, for instance, the drug-resistant tuberculosis germ that swept
through the city in the early 1990's, killing hundreds.
It was the rising tide of unnecessary anthrax panic that bothered the
doctors, and also the obsession with the antibiotic Cipro, when drugs related to
Cipro should also treat and prevent anthrax, and penicillin and tetracycline
should be safer and cheaper alternatives for most patients.
The anthrax discussion took half an hour. Then Dr. Baum steered the meeting
back to the usual weekly routine of hearing about other infections that somehow
never made it onto the front page:
After a 61-year-old man ate raw oysters at a city restaurant last spring, he
developed severe abdominal cramps and diarrhea. He had cholera. Sewage from
foreign tankers can easily contaminate shellfish beds with alien organisms. The
man was treated and recovered.
A 26-year-old Mexican had a cough for two years as he delivered packages. He
grew steadily weaker and sicker. When he came to Bellevue gasping for air,
doctors found his windpipe almost blocked by small growths caused by Klebsiella
rhinoscleromatis, a rare germ living in the soil of Central America. He was
treated and is recovering.
A 53-year-old woman with advanced ovarian cancer had one intestinal blockage
after another. She proved to have an infection with Listeria, the bacteria that
often contaminate cheese and processed meats. She was treated and felt better.
A 65-year-old New Jersey man developed a large sore in his genital area
that refused to heal despite dozens of tests and seven medications. It turned
out that he had sporotrichosis, a fungal infection from plants; he probably
picked it up when he urinated against a bush at his favorite golf course.
A 36-year-old woke up to find his face frozen. He could not raise his
eyebrows, smile or eat. Tests showed that he was newly infected with H.I.V., and
on treatment, his facial muscles began to work again.
By the end of the afternoon, anthrax had faded into the background, just one
more hostile particle to try to outsmart amid hundreds of others. |
