Webcast Transcript

Anthrax: What Every Clinician Should Know, Part 2

(November 1, 2001)

(View the webcast on the University of North Carolina School of Public Health site.)

Segment 10 of 10
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Dr. Burroughs:
Valentine Burroughs again. My question for Dr. Caine is, what methods are used to detect the various forms of anthrax in a patient?

Dr. Caine:
Anthracis can be isolated by culturing an organism from the blood or based on the lesion, if it is a skin lesion from vesicular fluid or from the lungs if you have pleural effusion. You can do a thoracentesis. Or if there are meningial or CNS involvement you can do a spinal tap. So it just depends on where the site of the organism is. And there are also some diagnostic tests where you can detect the antibodies in these particular clinical specimens as well. Initially, the standard procedure in the laboratories is, they are asked to do a Gram stain of the organism. Usually this organism is gram-positive and they’ll look for certain colony formations on the nutrient media. It grows very readily. And based on the characteristics of that colony, morphology, you know whether it is hemolytic and some other chemical tests that they can provide, they can make presumptive diagnosis. And look such issues as motility, lyses by gamma phage, some capsule production, and visualization, and even wet mount in a special staining for the spores that they can do. But these are the presumptive type of tests and you have to have someone that’s got a certain level of biological lab in order to do those confirmatory tests and there are not a lot of places where that is available and quite frequently they are carried out at CDC is the agency we hear the most frequent place besides some of the governmental and state labs, which can include those phase lyses, the capsular staining. This organism has a capsule and they can also use the direct fluorescent antibody test in order to make a rapid diagnosis besides a polymerase chain reaction test.

Dr. Bruce Butler:
Hello, my name is Dr. Bruce Butler. I’m the current Chief Medical Officer of the Federal Protective Service. My question is for Surgeon General Satcher. What are—given the approval rates of FDA—what are the current guidelines, treatment regiment for pediatric patients, and are they indeed FDA-approved?

Dr. Satcher:
Well, as you know with a lot of the drugs that we use in medicine, we don’t necessarily have clinical trials in children showing safety and effectiveness. So if you take ciprofloxacin, we do not have safety and effectiveness established for children. But now if you are asking me should we use it—if we had a new outbreak of anthrax and we had not had a chance to establish the sensitivity of the organism to other agents, I would strongly recommend beginning with ciprofloxacin even in children and use it until we establish the fact that the organism is sensitive to other agents. So it is like some other areas where we treat children using off-label approaches if you will because we are worried about the risk of death as opposed to the risk of the drug. Ciprofloxacin has serious side effects as you’ve heard, but if you have a child who is at risk of dying from inhalation anthrax you go that direction until you establish that that organism is sensitive to some other drug.

Dr. Caine:
I think we will take one more question if we could from the audience.

Dr. Butler:
Yes. Again, my name is Dr. Bruce Butler. I have a question about the use of these home testing kits that are being pushed on the Internet currently. We recognize that a lot of the population ran to purchase gas masks in the beginning of this crisis. We found out later on from the experts that it was not necessarily the best or wisest thing to do. Could you please comment? Thank you.

Dr. Khan:
I can comment. I assume that you are talking about these rapid hand-held assays that are being used by many first responders for testing environmental samples; is that correct, sir? CDC is actually in the process of evaluating that with our partners. But at this point I think it is fair to say that there is not one such assay, there are numerous such hand-held assays. Some have better sensitivity and specificity than others so it’s not appropriate to lump them together. But what comments you can lump together is that until we have a better assessment of them we do not recommend that you make any clinical decisions based on those assays. So if you have a powder and you think it is Bacillus anthracis, regardless of what your hand-held assay may say, we are recommending that, based on some criteria that have already been laid out about who gets tested, those samples go to a real lab for confirmation before you decide to make clinical decisions based on those assays. The only—if they are using some of the good assays, if it shows that it is B. anthracis, some people are actually starting prophylaxis immediately pending the confirmatory result. But the point is, do not use those hand-held assays as a final answer. They must go to a state laboratory, to a level B laboratory, for a confirmation of that sample.

Dr. Caine:
Before we close our program today, I just want to thank our invited guests and I want to thank you out in the audience for taking your time to participate in this broadcast. I want to send an especial thank you to the television crew here at the Howard University College of Medicine who have just been wonderful to work with and we want to thank you for all working so hard to make this program a success. And, before we close this program, I just want to re-emphasize, if you want some more information, contact the NMA Web site, which is www.nmanet.org. Now I would like to turn this over to Dr. Randall Maxey, who is the chair for the National Medical Association’s board of trustees, who prepared this videotape yesterday and had it flown here this morning.

Dr. Randall Maxey:
As chairman of the National Medical Association’s board of trustees, I hope this broadcast, “Anthrax: What Every Clinician Should Know, Part 2,” was informative and timely. As clinicians that serve a broad spectrum of patients, including minority and underserved populations, our preparedness to correctly recognize, test for, diagnose, and report cases that could be attributed to Bacillus anthracis exposure is of critical importance to combating the bioterrorist threat facing all Americans. We would like to thank the Centers for Disease Control and Prevention and the Public Health Training Network for their partnership in this broadcast.

This program, originating from the Howard University College of Medicine, has presented an update on clinical guidelines and procedures for the early recognition, diagnosis, treatment, and reporting of anthrax exposure. As additional cases of anthrax exposure are identified, the National Medical Association encourages all health professionals to prepare for a potential assault. This is history in the making, a 21^st century medical and social problem that requires strategic thought and active preparation to overcome this challenge. The National Medical Association embraces a system-wide approach to disaster preparedness that includes special training and development of uniform treatment protocols for health professionals including public awareness. Of great concern is America’s preparedness to protect the health and well being of its people. Superior surveillance and monitoring is of paramount importance as we attempt to curtail this potential crisis. Anticipation of the mode of transmission of the bioterrorist agents along with the type of agents used will be critical. Having an adequate and ready supply of medications, antibiotics, and vaccines must be part of our clinical arsenal. America has the capacity to successfully address this crisis if we take advantage of our short window of opportunity and capitalize on the advances in technology, information systems, and the medical sciences. This approach calls for collaboration in its purest form and function as one team with a common vision as we promote a nationwide counterattack on bioterrorism. The National Medical Association, the Centers for Disease Control and Prevention, and our other partners will continue to keep you abreast of the latest information updates pertaining to bioterrorism and uniform treatment protocols for clinicians. To access the NMA Web site, our address is www.nmanet.org. For the CDC, the address is www.cdc.gov. Like all Americans, the National Medical Association and its members are saddened by the recent terrorist activity in our nation. Through all of our efforts and partnerships, America will win this war on bioterrorism. Good day, and God bless America.

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