Feel flu coming on? Where do you work?

Health officials stress need for doctors to ask, given anthrax situation

War On Terrorism

Anthrax Scare

October 24, 2001|By Jonathan Bor and Greg Garland | Jonathan Bor and Greg Garland,SUN STAFF

Only a week ago, the question might have seemed mundane. But now, doctors greeting patients who complain of flu-like symptoms including fever, achiness and fatigue are asking a question that could save a life:

Where do you work?

The case of a Maryland postal worker who died of anthrax Monday - a day after being sent home from an emergency room with antacids - underscores the importance of getting an occupational history of patients whose symptoms might seem ordinary.

Doctors are loath to criticize physicians at Southern Maryland Hospital Center in Clinton for not initially recognizing postal worker Joseph P. Curseen Jr.'s symptoms as inhalational anthrax, a disease that can spiral downward to hemorrhaging, coma and death in a few days.

The early stages of inhalational anthrax are easy to confuse with flu, they say, and the evidence does not always turn up on chest X-rays and blood tests.

But many are quietly asking why doctors sent Curseen home without finding out that he was a postal worker, a job that sadly has come to be regarded as a risk factor for anthrax exposure.

Had the doctors known, they could have treated him with antibiotics on the assumption that he was infected.

Dr. Peter L. Beilenson, Baltimore's health commissioner, said he is telling doctors to give the preventive drugs to anyone with flu-like symptoms who is a postal worker, opened suspicious mail or had other possible exposures.

"History is absolutely crucial," Beilenson said.

"You've got to ask, `Where do you work? Do you work for anybody high profile? Have you been exposed to anything unusual? Have there been any threats against you?'

"There's no way you can diagnose early or even be suspicious of anthrax unless you get an occupational history."

Dr. Eric Toner, chief of emergency medicine at the St. Joseph Medical Center in Towson, said histories have always been important - but the questions have become more pointed in recent days.

"We want to know if they have handled any mysterious substances, work in a post office, hung out in a post office, and do they work in any buildings where co-workers have been sick," Toner said.

"It's a whole new world. We are thinking differently about every patient who comes in with fever."

At Washington Adventist Hospital in Takoma Park, doctors are giving antibiotics to anyone with even minimal symptoms who worked at one of the suspect postal facilities or on Capitol Hill.

Curseen, who worked on a coding machine at the Brentwood Central Mail Sorting Facility in Washington, started feeling ill Oct. 16 and thought he had a bad cold.

A neighbor said he went to the Southern Maryland emergency room that day, though it is unclear what happened at the time.

On Saturday, Curseen passed out while at church. His wife, Celeste Curseen, said he nonetheless insisted on reporting to work that night for a shift that began at 10:30 p.m.

However, not long after arriving at work, he felt so ill that he called his wife to tell her he was going back to the emergency room. Hospital officials said they took X-rays and blood tests and saw no indication Curseen had anthrax.

Believing he had stomach flu, they sent him home with Pepcid, an antacid.

Curseen called in sick the next night, and at 4:30 a.m. Monday his wife found him collapsed in the bathroom. He was taken to the hospital by ambulance and died six hours later.

At a news briefing Monday, Dr. Venkat Mani, the chief of the infectious disease unit at Southern Maryland, said that hospital physicians did not realize Cursee was a postal worker when they sent him home a day earlier.

Curseen's father said he did not want to place blame, but he said the hospital's failure to diagnose anthrax before sending his son home Sunday "will be a source of wonder for me for many years to come."

Dr. J. Glenn Morris, chief of hospital epidemiology at the University of Maryland Medical Center, said the evidence of anthrax might not show up on a blood culture before symptoms have become severe.

One of the classic signs, the widening of a chest cavity known as the mediastinum, doesn't usually occur until the patient is close to death.

Although he didn't know the details of the Curseen case, Morris said doctors can be guided by a patient's history.

"Get into the history, find out about the exposure," he said.

If the patient has a risk, he said, "the better part of valor" might be to treat the patient with antibiotics as a precaution.

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