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ODs can evaluate patients for natural disease vs. bioterrorist-inflicted bacteria
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WASHINGTON — Experts from the Public Health Service are suggesting that health care practitioners in all areas of medicine thoroughly question patients to differentially diagnose a natural disease-related bacterial development vs. a bioterrorist-inflicted potential risk.
This was the take-home message when four Public Health Service experts — Anthony Fauci, MD, the National Institutes of Health’s director of the National Institute of Allergy and Infectious Diseases (NIAID); Peggy Hamburg, MD, the former New York City health commissioner; David Franz, DVM, Col. (Ret.), the former commander of the U.S. Army’s Medical Research Institute on Infectious Diseases; and Michael Osterholm, MD, the former Minnesota chief epidemiologist — met Nov. 5, 2001, with more than 100 metropolitan Washington professional and consumer health care and science writers. They also discussed how medical providers, public health officials and the justice department have been and should be communicating information about the bioterrorist release of anthrax spores.
The epidemiology of Bacillus anthracis has been changing daily, from redefining its LD50 to decontamination modalities, establishing risk assessments for potential additional aerosol contamination and dispensing appropriate medications and dosages for treatment prophylactically.
The experts urged practitioners to follow investigative reporting techniques and ask numerous questions of patients. Management of potential and acute bioterrorist agent infections begins with the differential diagnosis, so a case history of onset, duration, signs and symptoms should be followed by assessing the patient’s high or low exposure probability risk.
Ocular effects of oral agents
Any patient with skin rashes and melanoma-like lesions on the face and eyelids, along with hemorrhagic conjunctivitis, corneal ulceration or keratitis should be closely evaluated.
Eye care practitioners are familiar with ciprofloxacin as a 0.3% ophthalmic solution and ointment. It is frequently administered as a presurgical prophylactic against postoperative infections or to treat conjunctivitis and corneal ulcers. Patients taking oral ciprofloxacin against B. anthracis may experience the following adverse drug effects: facial edema, phototoxicity, skin rash, headaches, blurred vision, changes in color perception, reduced visual acuity, diplopia, ocular pain and nystagmus.
Oral doxycycline is also being used against B. anthracis. This agent is a bacteriostatic antibiotic that inhibits protein synthesis, and its side effects are phototoxicity and maculopapular and erythematous rashes.
Emotional effects of events
Since the events of Sept. 11, fear and anxiety have increasingly become widespread among all patient populations. As a result, mental health care providers are prescribing more anti-depressant and anti-anxiety medications. Alternative health care providers are recommending over-the-counter (OTC) herbal dietary supplements.
Ask your patients about both prescription and OTC supplements, as there may be contraindications with other medications. It also may be necessary to discontinue herbals temporarily if your patient is scheduled for surgery.
The American Dietetic Association and grocery stores are finding an increase in comfort food purchases to reduce Sept. 11 stress and anxiety. Eye care practitioners should advise diabetic and cardiovascular disease patients about the importance of adhering to a recommended diet to avoid ocular and systemic complications.
Lead and arsenic
| The OD's role in diagnosing possible toxicity | |
| After obtaining in-depth patient histories,
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The Centers for Disease Control and Prevention (CDC) released its first toxic exposure study of 27 environmental chemicals on 3,800 American children and adults in U.S. history 6 months before the first anthrax bioterrorism fatality. Its indication of reduced lead concentration is disputed by other researchers who believe between 10% and 30% of American children have toxic amounts of more than 10 mcg in their blood. Its toxic sources include drinking water, lead exposure in certain occupations, eating foods grown in lead-containing soil and air circulating in homes built before 1950.
Lead toxicity inhibits absorption of iron, zinc and calcium, which is necessary for proper brain and nerve development; disrupts dopamine release for numerous brain functions; causes reading disabilities, speech delay, hearing loss and balance difficulties; impairs IQ in children; causes cognitive decline and reduced brain functioning in mature adults; and causes premature aging by up to 5 years. Headaches can be symptomatic of poisoning from this hazardous material.
Arsenic was used in World War I chemical weapons testing by the U.S. Army, but it was again discovered in 1986 in the Spring Valley section of Washington. It causes skin rashes and cancer of the skin, lungs and bladder; damage to blood vessels and nerve function; and aplastic anemia. While it is known that the agent was released into the soil, it is also presumed to have been released into the air. This hazardous material may be the cause of health problems in children and adults who reside in this area, as well as in American University students. This soil now will be evaluated by the U.S. Army Corps of Engineers.
The Environmental Protection Agency, on Oct. 31, 2001, adopted legislation to continue allowing arsenic’s 10 parts per billion as the drinking water standard to “protect against the risk of cancer, heart disease and diabetes” according to Director and former N.J. Gov. Christine Todd Whitman. Other communities throughout the United States are evaluating additional trace metals along with viral and bacterial pathogen-causing illnesses in the soil and water.
On May 16, 2001, National Institute of Neurological Disorders and Stroke Acting Director Audrey Penn, MD, requested increasing her NIH institute’s budget for FY2002. She cited that toxic exposure damage causes numerous burdens that affect the brain, nerves and muscles of the body and create neurological disorders.