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SYMPTOMS

Is it just the flu?

By Raja Mishra, Globe Staff, 11/4/2001

   
 KEEPING SAFE

Articles:
How genuine is the risk?
Taking practical steps
Staying safe on the job
Handling new kind of stress
Talking with children
Is it just the flu?
What to do when in doubt
Hospital readiness
How the body fights back
Are there other threats?
Not all terror threats equal

Graphics:
How to talk to your kids
5 signs you need help
What works, what doesn't
How anthrax is diagnosed
Inside a bacterial invasion
In case of emergency...
Identifying a mail threat
Safety resources

Compare cold & flu to other bioterror threats:
Cold & Flu
Anthrax
Botulism
Hemorrhagic Fever
Plague
Smallpox
Tularemia

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More anthrax coverage

Doctors await the deluge: frantic calls from people with seasonal sniffles convinced they're victims of bioterrorism. After all, most discussions of anthrax inevitably mention its ''flu-like'' symptoms.

But there are differences. Anthrax produces more intense, lower-body fatigue than the flu. And the sore throats and runny noses associated with the flu are less prevalent among anthrax victims.

An understanding of the subtle distinctions between anthrax and flu symptoms - and the ease with which doctors can tell them apart - might help ease concerns this winter.

If there is any up-side to the anthrax outbreak, it is that scientists have gained, in just weeks, a far better understanding of the disease than ever. Last week, doctors compared notes on the 10 patients so far who have contracted inhalation or respiratory anthrax, the more serious form of the disease. Four died, while the rest are recovering with antibiotics.

Initial inhalation anthrax symptoms resemble a common cold. But the 10 patients also had fevers, night sweats, chills, and shivering. These are uncommon in typical flu patients. And the fatigue accompanying the anthrax was intense: Patients were unable to rise from bed, spending entire days prostrate. Flu sufferers can usually carry on with daily life.

The flu, on the other hand, causes runny noses and sore throats. These were not pronounced symptoms in the 10 cases. And the flu typically produces muscle aches and headaches. The anthrax victims did not experience these to any significant degree.

''Basically [anthrax symptoms] are a very severe form of the flu, with much less prominence of upper respiratory problems, like runny noses and sore throats, and much more extreme fatigue,'' said Dr. Stephen Calderwood, chief of infectious diseases at Massachusetts General Hospital.

Scientists also found that the sputum - saliva and phlegm discharges - of anthrax patients remained relatively clear in color. In flu patients, sputum is often yellowish.

Anthrax and flu are literally different creatures. Anthrax is caused by the single-cell Bacillus anthracis bacteria that wreaks havoc by secreting a toxin while in the body. Flu is caused by a virus, less complex than bacteria, that invades and damages healthy cells in the body.

Within days or even hours, anthrax becomes far more serious than the flu, as victims develop extreme breathing difficulties and a spike in blood pressure. Without antibiotics, they enter shock; some develop meningitis and 80 percent die. This happened with two Washington, D.C., postal workers and an editor of a tabloid newspaper in Florida.

Meanwhile, the flu might pass in a week, with all symptoms gone in three. It is mostly a danger to the elderly, although the disease is so widespread that an estimated 10,000 to 20,000 people die from the flu annually. Millions more weather it just fine.

Given anthrax's lethal speed, many people who experience flu-like symptoms will not want to take chances in this climate of fear. Fortunately, a quick checkup can clear matters. First, doctors will ask questions: What are your exact symptoms? Are you a postal worker? Do you handle animals such as cattle in which anthrax is common? They will probably take a chest X-ray and blood samples. Within hours they will have a solid diagnosis.

It's worth noting that nasal swabs are not tests for anthrax infections. They test for the presence of anthrax, which is not the same as an active anthrax infection in which the bacteria release toxins into the body. Someone who tests positive for exposure will receive antibiotics and a blood test for infection, but nasal swabs are used primarily for detective work.

When the Florida editor died, investigators took nasal swabs of his fellow employees and family at home, trying to determine the path the anthrax spores had followed. Mail room employees at his office tested positive for exposure, and they were quickly able to focus their investigation on the mail.

Only blood tests can confirm infections. Doctors can run several tests on blood to detect the presence of anthrax bacteria. Almost any hospital can do one, with strong results, both positive and negative, ready in an hour and definitive results in a day.

A person can also get anthrax by swallowing contaminated food, though there have been no intestinal cases in the current outbreak. Initial symptoms include nausea, loss of appetite, vomiting and fever, followed by abdominal pain, vomiting of blood, and severe diarrhea. Without antibiotics, 25 percent to 60 percent of these cases are fatal.

There are six confirmed cases of cutaneous or skin anthrax and other unconfirmed cases in the current outbreak. In these cases, anthrax enters through a cut in the skin. A welt develops, becoming a blackish scab. It might be painless and sometimes, though not always, is accompanied by fever. It is the least fatal form of the disease: even untreated, four out of five victims survive.

In these uncertain times, health officials are preparing for a host of other possible bioterrorism afflictions. Here are the symptoms of other biowar agents they are concerned about:

Smallpox. This virus has ravaged whole nations, killing close to half a billion over the centuries. It is highly contagious, spread through saliva droplets. About 30 percent of those infected die. The initial symptoms include high fever, fatigue, and head and backaches. Then, in two or three days, comes the characteristic rash, which tends to be most prominent on the face, arms, and legs. The lesions soon become pus-filled, then develop crusts, which scab and fall off within a month. Vaccine treatment in the first four days can help, but otherwise doctors are relatively helpless, and patients would probably be placed in isolation wards.

Botulism. This toxin is not contagious but can be spread through contaminated food. It basically paralyzes a person, beginning at the head then working its way down. Early symptoms include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, and dry mouth. Then muscle paralysis descends through the body: first the shoulders, then upper arms, lower arms, thighs, and on down. Paralysis of lung muscles can cause death unless a ventilator is used to aid breathing. There are drugs to lessen botulism's effects, and most patients, with care, recover in weeks or months.

Pneumonic plague. This bacteria is the Black Death of old, spread by infected rats and fleas. The first symptoms are fever, headache, weakness, and bloody coughs. In two to four days, it causes septic shock and death. It can be spread through saliva droplets. But early treatment with antibiotics usually saves victims.

Most hospitals can quickly test for any of these pathogens. And though most doctors have not treated any of the afflictions in their lifetimes, the medical establishment recently began a massive educational effort at every urban and suburban hospital. Literature with detailed clinical information on each was given to infectious disease specialists, who in turn are helping to train emergency room doctors and clinicians who might be the first to see patients with symptoms.

In the case of anthrax, in particular, the incessant media coverage has made most every doctor - and potential patient - acutely aware of the symptoms and treatment.

''I'm fairly confident that we're prepared for any of these,'' said Calderwood at Mass. General.

This story ran on page 8 of the Boston Sunday Globe's Common-sense Guide to Keeping Safe on 11/4/2001.
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