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Is it flu or anthrax?

MSNBC STAFF AND WIRE REPORTS

WASHINGTON, Oct. 25 — With anthrax-wary Americans on edge over every cough, sniffle and ache, doctors around the nation are gearing up for a confusing influenza season. Since both illnesses start with similar symptoms, how can you tell if you have the flu or anthrax?

IN WASHINGTON, Dr. Byron Cooper’s office is being besieged by calls. “The question is: ‘I received mail from D.C. I want to be screened,”’ said Cooper, a pulmonary internist who is not recommending anthrax tests for people who have not been exposed. “I had so many of those types of calls that I got like an hour behind.”

He expects more calls as winter approaches and people get colds and fevers.

“The flu is going to be a confusing matter,” Cooper said. “So far, my patients are calling without symptoms, except one who had a scab inside her nose and wondered whether that was from inhalation anthrax.

“Anyone who calls with flu symptoms, I’m going to tell them they need to come in and be evaluated. I’m sure we’ll be deluged.”

SIMILAR SYMPTOMS

The symptoms, especially in the early part of inhalation anthrax, are the same, said Dr. Mark Oberle, associate dean of the School of Public Health at the University of Washington in Seattle. “The early signs are virtually indistinguishable — fever, headache, muscle aches,” he said.

While there’s no way to distinguish between early inhalation anthrax — which can occur when anthrax spores are breathed in — and the flu without doing specialized tests, there are some clues, said Dr. Meryl Nass, an anthrax expert in Brunswick, Maine, who is helping design a practice case to help doctors diagnose anthrax. She read from a list of symptoms in a hypothetical case: “Nasal congestion, sore throat, low grade fever and a cough that is occasionally productive of sputum.”

Thompson pushes for faster flu shots

This patient probably did not have anthrax, she said. “Anthrax doesn’t cause sputum,” she said. “Although people may be short of breath and they might have a dry cough, they are not producing anything in the lungs.”

Also, Oberle said that while a runny nose sometimes accompanies the flu, it would not be a sign of anthrax.

While the initial signs of inhaled anthrax are flu-like, several days later, symptoms can progress to severe breathing problems and shock.

“If you have the flu and have severe breathing problems, even without the anthrax threat, you should go to the doctor anyway,” Oberle said.

FLU SHOT SHORTAGE

To help head off hordes of people with achy muscles and a cough scrambling to the emergency room, Dr. Mohammad Akhter, executive director of the American Public Health Association, urges Americans to get vaccinated. “The best thing this flu season really is to go get the flu vaccine so you can at least rule that possibility out,” he advised.

“All of us are pushing the flu shots so we can cut down on symptoms that look like anthrax,” said Dr. Barry Prystowsky, a pediatrician in Nutley, N.J., who is sticking all his patients with needles full of flu vaccine.

But that advice is prompting further confusion — with a delay in flu shot production this year, the Centers for Disease Control and Prevention is asking people who aren’t at high risk for flu complications to wait until November to get the vaccine.

The CDC urges health workers and people over 65 or those with chronic health conditions such as heart disease, diabetes, asthma, cancer, kidney disease and HIV to get vaccinated promptly. Healthy people who want to ward off the flu are urged to wait until some time in November when more supplies become available.

“Our recommendations haven’t changed,” said CDC spokesperson Charles Fallis.

The CDC expect nearly 80 million doses of the flu shot will be available this season, which the agency says will be sufficient for the demand.

“It takes a week to 10 days to take effect so keep trying, call your physician or health department to find out where and when it’s available,” he said. Flu season usually peaks in January or February so there’s still time for the shot to offer benefits, he noted.

But Oberle said that if you get the flu shot and still come down with flu-like symptoms this winter, don’t jump to the conclusion that it’s anthrax. Many different viruses and other conditions share the same symptoms. Just call your primary care doctor and describe your symptoms, he advised. At this point, health officials say, the flu poses a much greater public health threat to Americans than anthrax. While a dozen people have been diagnosed with anthrax, each year an estimated 25 million to 50 million Americans contract the flu. Most people recover in a week or two, but the flu can be life-threatening for the very young, the old or those with chronic disease. While only three people have died from anthrax, about 20,000 die from flu complications each year. OTHER FORMS OF ANTHRAX The symptoms of the other two types of anthrax are more distinctive than those of the inhalation form of the disease. The most common form of anthrax is cutaneous, which occurs when the germ enters an abrasion on the skin. The infection begins as a raised itchy bump similar to an insect bite that develops into a fluid-filled sac within a day or two. Then it becomes an ulcer with a dark area in the center — the hallmark of cutaneous anthrax. Initial signs of intestinal anthrax, which can follow eating contaminated food, are nausea, loss of appetite, vomiting and fever. Then, abdominal pain, vomiting of blood and severe diarrhea can develop. Experts say people should be aware of early symptoms of anthrax because when caught early it can be effectively treated with antibiotics.

-- Anonymous, October 27, 2001