Docs Still at Front Line in Detecting Bioterrorism

Oct. 26, 2011— -- Some individual clinician will be the key player the next time there's a covert bioterrorism attack, like the anthrax episode a decade ago.

Despite a marked increase in resources aimed at detecting and foiling bioterrorism, "it's going to be a practitioner who diagnoses the next covert attempt," according to Dr. Larry Bush of JFK Medical Center in Atlantis, Fla.

Read this story on www.medpagetoday.com.

Bush should know. He made the initial diagnosis of anthrax inhalation after a confused and feverish Robert Stevens walked into the emergency ward on Oct. 2, 2001 -- a diagnosis that kicked state and federal health agencies into high alert and probably saved dozens, if not hundreds, of lives.

"What I saw was a man who -- according to his wife -- drove home 24 hours earlier from North Carolina and now was comatose, on a ventilator, and had meningitis," Bush told MedPage Today.

He and colleagues took spinal fluid from the comatose Stevens and Bush noted a preponderance of white cells, indicating inflammation, as well as the telltale boxcar shape of bacillus cells.

"A bacillus that causes meningitis is very rare," Bush said, and Steven had none of the usual precursors of more common infections, such as head trauma.

Of course, he also had none of the common precursors of inhalational anthrax, such as working with hides or in a lab that deals with the pathogen, and for many doctors that would have been that.

The medical school adage about horses and zebras would have kicked in and the incredibly rare diagnosis of anthrax -- 18 cases in the U.S. in the previous century -- would have been dismissed as a zebra.

But Bush took a different view. "In the worst case, this is anthrax," he thought. "And if it's anthrax, it's bioterrorism until proven different."

He notified health authorities and the rest is history.

The story as it unfolded: