|Army Doctors Work for Better Anthrax Tests |
Army Doctors Work for Better Anthrax Tests
By Beau Whittington, Army News Service (*).
Washington D.C. – (ANS) December 3, 2001 -- A team of Walter Reed doctors just got the go ahead to test a protocol for anthrax. The protocol could provide better diagnostic tools for the deadly spore.
As American concerns over anthrax exposure grow, so does the realization of how little is known about timely diagnosing the disease.
Since the first spore-carrying letter was delivered to the American Media offices in Boca Raton, Fla. last month, nasal swabbing has become the gold standard for detecting exposure. Positive swabs show individuals have been exposed, and everyone in the area should be treated.
"Unfortunately people have gotten into their minds nasal swabbing is a test used to rule out anthrax," Lt. Col. Clifton Hawks said. Hawks is chief of Infectious Disease at Walter Reed and associate investigator for the study. "This has become a false reassurance." Nasal swabbing is a survey tool used to show people have been "exposed to, not infected with, anthrax," he stressed.
The research team will analyze what Walter Reed's Department of Medicine chief and chief investigator, Col. Bill Duncan, defines as a "unique military threat -- the possibility of anthrax attacks in the field."
Investigators will study subjects who become exposed to anthrax spores but have not developed infection symptoms. They will consider three different aspects of a potentially fatal infection.
First, they will compile information on people who undergo a creditable anthrax exposure. Investigators will follow the subjects for about 90 days, storing blood samples and DNA from the cells. As better infection testing becomes available, they will use these samples for further testing. Duncan said this will provide hard clinical information on how anthrax infections develop. While this will not immediately benefit patients, he describes it as a "potential big bang for future studies."
The second leg of the study will begin when doctors decide to treat patients with antibiotics. Study participants will receive one of the two drugs known to be beneficial in treating the disease -- ciprofloxin or doxycyline. Investigators will follow patients throughout their 60 days of medication, checking for compliance, side affects and any reasons for stopping treatment.
This will provide a carefully collected body of information about the medications. The study could also show one drug might be preferable to the other, and any risks the medications present.
While a few clinical studies provide some of this information, Duncan said the drugs have never been studied side-by-side.
The third part of the study involves using nuclear medicine to track infections. This area draws the most interest because it could drastically reduce diagnostic time frames, according to Duncan.
Under the protocol, investigators will attach radiological trackers to white blood cells, using a drug called LeuTech.
"White cells continually head for infection sites," explained Lt. Col. Robert Bridwell, assistant professor of radiology and nuclear medicine for the Uniformed Services University of the Health Sciences. "Through an injection, the medication hitchhikes a ride on the back of the white cells as they head for the infection, allowing us to more easily identify infected areas," added Bridwell, associate investigator for the study.
The procedure offers a non-specific identification of infections, he said, but he believes researchers can use anthrax's individual characteristics to offer early diagnoses.
Anthrax typically attacks the lymph nodes in the center of the chest. Recognizing the pattern distinguishes anthrax from other respiratory diseases. Previously, the disease was virtually fatal when it entered the lungs because, once lymph nodes became enlarged enough to diagnose, the infection is too advanced to treat. Bridwell believes early detection, coupled with new antibiotics, can greatly reduce mortality rates.
"You know what you see," Hawks explained about the limited knowledge on anthrax diagnosis and care. "Since we rarely see anthrax in this country, it's not on your radarscope all the time."
He referenced the first fatality in Florida. "[The patient] came with fever, muscle pain and was just feeling bad," Hawks said. "The symptoms were so non-specific [the patient] could have had any number of viral syndromes."
By the time diagnoses are made with current protocols, patients are near death. Keeping the disease on the radarscope and earlier diagnosis are the only way to protect soldiers and the American public from such terrorist attacks, Hawks said.
(*) Editor's note: Beau Whittington is the assistant editor for the Walter Reed Army Medical Center Stripe newspaper.