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Hospital Officials Discuss Anthrax Case

Aired November 21, 2001 - 09:17   ET


LEON HARRIS, CNN ANCHOR: We want to take you now to Derby, Connecticut, so we can get the latest on that woman who has the inhaled version of anthrax.


PATRICK CHARMEL, PRESIDENT, GRIFFIN HOSPITAL: ... informed by the state health department, and confirmatory testing performed by the CDC, in Atlanta. Those are the test results we received.

The patient's condition remains critical.

I wanted to compliment publicly the care team that has been involved in this patient's care from her initial presentation in Griffin Hospital, on Friday, beginning with our emergency department physicians; our laboratory staff in microbiology, who initially isolated the bacteria that ultimately turned out to be anthrax; and then the physicians, to my right and left, who have been involved in this woman's care, again, since arriving at the hospital.

Let me again introduce the people here with us this morning: Dr. Stephanie Wain -- Dr. Stephanie Wain is the chairman of pathology and laboratory medicine here at Griffin Hospital; Lydia Barakat, who is an attending physician, and infectious disease specialist; her associate, Dr. Howard Quentzel, also an infectious disease specialist in the chief Griffin section division of infectious disease in the Department of Medicine; Dr. Kenneth Dobuler, who is a pulmonologist, and he is chairman of the Department of Medicine here at Griffin; and Dr. Stephen Spear -- Dr. Stephen Spear is an attending physician, an internist, and the patient's private physician.

We're prepared to answer any questions you might have this morning.

QUESTION: How is the patient responding to antibiotics, and what is the prognosis right now?

CHARMEL: The patient's condition is critical. We can't respond beyond that condition report at this point.

QUESTION: Because you caught up so early and were able to treat her, how is she responding to the antibiotics?

CHARMEL: Again, we did find and were able to, because of the diligence of all of those involved in her care, did identify the possibility of anthrax very early and treatment started very rapidly, so this woman given the best possible chance of surviving this very serious disease. And that's all we can say.

QUESTION: You can't say more about how she is responding and what...

CHARMEL: We cannot at this point.

QUESTION: How about in general as to a patient at her stage of the illness -- what symptoms does a patient exhibit at that stage?

CHARMEL: We can talk in general about anthrax infection and how that disease progresses, but we can't talk specifically about this particular case.

And I think the best person to answer that question is Dr. Howard Quentzel.

QUESTION: Sir, who's the doctor that first thought we should we should check for anthrax? (INAUDIBLE) What made them think that -- because that's, obviously, very quick thinking on their part.

CHARMEL: That person is Dr. Barakat, and we will let her speak after Dr. Quentzel answers the first question, which was just generally how doe this disease progress. If you don't mind. Then Dr. Barakat can talk about the initial laboratory findings and her suspicions and how she proceeded from there.

Good morning.

QUESTION: For a patient who is quite advanced in the illness, what symptoms are they exhibiting at this time?

DR. HOWARD QUENTZEL, GRIFFIN HOSPITAL PHYSICIAN: Patients with inhalational anthrax often present initially with fever and nonspecific symptoms that will in the case of anthrax progress somewhat rapidly to a more serious form of lung disease and respiratory distress and often other organs involved. The cases that we know so far that -- the 10 cases prior to this one -- all presented in a similar fashion, with abnormal chest x-rays and respiratory failure.

QUESTION: How critical is it that you were able to identify it so early and start those antibiotics early in terms of a prognosis of somebody in this condition?

QUENTZEL: I think when we treat patients, we have to take into consideration all the factors, including a patient's age and other illnesses. So I think that early treatment is helpful and is what we strive to do.


QUENTZEL: No, this is the first case of anthrax that we've had here, and the first case of inhalational anthrax, as far as we know, in Connecticut.

QUESTION: (OFF-MIKE), or did you feel prepared to deal with this?

QUENTZEL: I think the last two months we've been all learning a lot. Based on a lot of the prior cases -- this has been new for all of us. But we have in a very short time become very proficient in trying to recognize the symptoms, and I think that helped us in trying to identify this very early.

QUESTION: Doctor, how is she doing? Can she breathe on own? Can she talk?

QUENTZEL: She remains very critical. We really don't want to disclose any more information about that.

I think Dr. Barakat saw the patient soon after the patient was admitted and might want to discuss a little bit about her initial valuation.

DR. LYDIA BARAKAT, GRIFFIN HOSPITAL PHYSICIAN: The patient was admitted on Friday afternoon for upper respiratory symptoms, and within hours her blood culture turned out to be positive for (UNINTELLIGIBLE). And there are few bacteria that can present like this, including bacillus anthrax. So I was called the following morning because of the positive culture.

And when I saw the patient, we kind of raised all these possibilities, and she was treated for most of the common pathogens, including anthrax. By Sunday, she started showing respiratory deterioration as far as x-ray finding and so forth, and we were able to isolate this bacteria as a bacillus species. And there are two tests that Dr. Wayne can comment on that we can do in our lab to differentiate between bacillus (UNINTELLIGIBLE), which is a fairly common pathogen and the other species of bacillus which are more severe. And it turned out to be this bacillus in particular is the nonmortal, so this was another flag for us that this might be anthrax.

At this point, the patient was on appropriate antibiotics, but the CDC was called and the state lab, and they did further testing and the case was confirmed.

QUESTION: Doctor, you said that you got this early. I am not sure whether this question is for you or any of the other doctors. You said that you caught this fairly early. Is there any way to quantify or to be more specific.

BARAKAT: Within hours, I would say.

QUESTION: Could you give us any indication based on what you've seen...

BARAKAT: The patient had symptoms for two days before she came to the hospital. And by the time she came to the hospital until she received treatment was hours. QUESTION: Could you give us any indication -- I know that sometime it's difficult -- based on what you've seen of this particular patient, just how much anthrax got into her system? Is there any speculation that can be done about what position she might have been in to have contact with this?

BARAKAT: It's very hard to tell. You know, we're learning from the other cases, and we know now from a fact that what we know from anthrax, that you need a large amount of spores to cause illness -- this is not the case because of the way they changed the spores and they were associated with other particles to make it more volatile. To be specific about this particular patient, it's going to be very hard to tell.

QUESTION: Prior to all the anthrax cases we've had across the country, do you think you would have been as keenly aware of the possibility of anthrax?

BARAKAT: We have a good lab and laboratory personnel here, and we always do our best to identify what bacteria we're working with, whether it's anthrax or other anthrax. So the challenge of making the diagnosis makes us very aggressive.

Of course, now that this is again a pathogen that we see clinically, it's going to raise more suspicion than years ago.

QUESTION: What did the abnormal x-ray look like?

BARAKAT: I can tell in general. But I am not going to comment on this particular patient. In general, you know from what was described already: They speak about widening of the (UNINTELLIGIBLE), bilateral hemorrhagic (UNINTELLIGIBLE) infusion. But I'm not going to comment about our patient at this point.

QUESTION: Are you suggesting that any of her close family or relatives should be treated with antibiotics as a precaution?

BARAKAT: I would leave it up to the CDC, the state officials, and the FBI. It's not our decision at this point.

BARAKAT: Is there anyone else who has come into the hospital at this point...

HARRIS: We've been listening to officials at the hospital there in Derby, Connecticut. They've been talking about the case of this 94-year-old woman who contracted inhalation anthrax sometimes last week, it appears. She is now in the hospital. The latest information that we've gotten about her condition is that it remains critical. The doctors were very adamant about not giving any other information about her condition. They wouldn't even tell if she's speaking right now. They wouldn't even tell us if she has responded at all to any of the medication that she has received, even though they did tell us that they did get the medication to her early enough to give her a good chance to fight this bacteria off within her body.

Dr. Sanjay Gupta, our medical correspondent, has been listening with me as well.

Anything that you glean from this?

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: It's sort of a fascinating story of how they go about figuring this out, Leon. You hear that they did five different tests, really, beforehand, and they were honing it down, narrowing it down -- they know it's a bacteria -- to these Five different tests, each one of them actually honing it down to try to determine whether it's bacillus anthracis, the bacteria that causes anthrax, and subsequently getting that DNA test by the CDC confirming that.

It's hard to know, Leon, as far as her particular condition. She is 94 years old. She was pretty sick, it sounds like, before she went to the hospital. We do know that that is a bad sign, usually, in terms of recovery overall.

HARRIS: Let me ask you about this testing process. We heard Dr. Barakat describe it. How long is that process normally? How long does it take? Is it something that in this case they had to expedite and rush through quickly because of their suspicions about this case?

GUPTA: It certainly sounds like they did at the CDC level. From what I understood, Leon, it was just last night when they got the blood with the bacteria in it, and by this morning, we're actually able to isolate the bacteria and then confirm that, in fact, it is anthrax, using DNA testing. So pretty rapidly -- it sounds like less than 24 hours for sure.

HARRIS: What's interesting is that they are trying to go back when they think she might have been exposed.

She was admitted Friday, but she exhibited symptoms two days earlier -- what does that tell you?

GUPTA: That's the concerning part. A lot of these folks who have been treated with antibiotics before they ever develop symptoms have a very good chance of never developing symptoms, certainly never getting sick, as this unfortunate woman is. She had symptoms for two days already. At 94 years old, her immune system is not going to work as well. All those things are very concerning, Leon.

HARRIS: Thank you very much, Dr. Sanjay Gupta.




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