In response to reports of two people who have been exposed to anthrax in Florida--one of whom recently visited Duke--the North Carolina State Health Department released a memo to all Duke University Health Systems employees Monday.
"Although the site of infection appears to be isolated to Florida, it is important that all health care providers be particularly attentive for the presence of signs and symptoms of anthrax among patients presenting for care over the coming weeks," the statement said.
According to the memo, anthrax is caused by a large, spore-forming, rod-shaped bacterium. The disease is contracted either cutaneously, gastrointestinally or by inhalation. The majority of cases occur through occupational contact with infected animals or animal products, and the disease can be treated by antibiotics.
But the memo stressed that "naturally acquired inhalation anthrax is exceedingly rare, and its appearance should immediately raise suspicion of an intentional infection using a biological weapon."
These sentiments were echoed by Dr. Dan Sexton, a professor of medicine in the Division of Infectious Diseases. "The last time this disease had been reported [in the United States] was in 1976, and suddenly, you hear of [these reports] in the face of the recent events," he said. "The widespread suspicions among specialists is that there may be some connection with terror and criminal behavior."
However, officials stress there is little risk associated with Duke. "Anthrax is not a communicable disease so the fact that [the first patient] came here is not important. What will be is figuring out the source of [the organism] in that office building in Florida," said Dr. Neil MacIntyre, professor of pulmonary medicine. "Duke and this matter are disconnected."
In a complex process, the bacterium invades the lymph nodes and is excreted into the blood flow. This triggers immediate and often fatal destruction of vital tissues. People with inhalation anthrax, like the two cases identified in Florida, typically show flu-like symptoms initially, and then develop severe respiratory illness, high fever, hemorrhagic gastroenteritis or meningitis.
The average time interval between onset of the initial stage and death is three days.
"I think people realize that [this disease has] the potential to be absolutely horrible, inhumane," said Sexton. "It's a disease of antiquity, and naturally occurs in animals, but dispersing the organism in unnatural ways is the terrifying part of it."
To treat it, early antibiotic treatment is essential, although mortality may still be high after the onset of symptoms. There is an anthrax vaccine but any vaccine is only effective if used prior to exposure to the bacterium. It is currently used primarily by the military, veterinarians and farm workers.
"These events have made everyone insecure," MacIntyre said. "As health care workers, [Duke care providers] are exhibiting heightened awareness, and have a lot of concern about the biological impact of something like this."
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