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Terrorism's Toll Lingers

Anthrax survivors suffer long after attack, finds study

TUESDAY, April 27, 2004 (HealthDayNews) -- The effects of an anthrax infection don't come and go quickly, and they linger in the mind as well as the body, reports new research.

In fact, the study, which appears in the April 28 issue of the Journal of the American Medical Association, found that as long as a year after being infected with anthrax, survivors of the disease still reported health problems, psychological distress and poor life adjustment.

"The anthrax survivors were all suffering a year after," said Dr. Dori Reissman, a senior advisor for emergency preparedness and mental health at the Injury Center at the U.S. Centers for Disease Control and Prevention. "Their ongoing health problems look a lot like those of survivors of other trauma," she said.

In the fall of 2001, envelopes containing the infectious agent Bacillus anthracis were shipped to various political figures and media outlets. As a result, 22 people were infected with anthrax. Eleven contracted the more deadly inhalation anthrax, and the other 11 developed the form of the disease that mainly affects the skin, cutaneous anthrax. Five people with inhalation anthrax died.

For the current study, the researchers contacted survivors of the anthrax attacks and asked them to complete medical questionnaires, participate in an in-person interview, and allow the researchers to review their medical records. Fifteen survivors, including all six with inhalation anthrax and nine with cutaneous anthrax, participated in the study.

All of the survivors were receiving psychiatric services at the time of the study. Eight survivors had not yet returned to work.

"We found a combination of psychological as well as physical problems," Reissman said.

The most common problems reported were respiratory tract difficulties, such as chronic cough, fatigue, painful joints, memory problems, depression, anxiety, obsessive-compulsive behavior and hostility.

Survivors of inhalation anthrax generally reported more problems than those with cutaneous anthrax. All of those with the inhalation form of the disease reported cardiopulmonary symptoms compared to 78 percent of the cutaneous survivors. Gastrointestinal difficulties troubled 50 percent of the inhalation survivors vs. 67 percent of the cutaneous survivors. Joint or bone problems were reported by 83 percent of those with the inhalation form compared to 56 percent of the cutaneous group.

Reissman said the researchers reviewed the medical records to try to find the cause of the ongoing physical symptoms, but couldn't find medical explanations for them.

"These symptoms may be a result of infection, but they may well be associated with the psychological trauma of being exposed to a bioterrorism agent," said Dr. Jerry Zuckerman, an epidemiologist in the division of infectious disease at Albert Einstein Medical Center in Philadelphia.

"Sometimes with infections," he added, "when the infection is treated, the body can have an autoimmune response and some of the antibodies to the disease start attacking the body."

Reissman said the study points to the need for psychological care for victims of trauma as well as physical care.

"This study shows that integrative systems of care are really very important for victims of trauma. These are victims of bioterrorism. If we want to maximize recovery, we need to focus on psychological as well as physical aspects of care," she said.

The case remains unsolved.

More information

To learn more about anthrax, visit the U.S. Centers for Disease Control and Prevention or the National Institute of Allergy and Infectious Diseases.

SOURCES: Dori Reissman, M.D., M.P.H., senior advisor, emergency preparedness and mental health, Injury Center, U.S. Centers for Disease Control and Prevention, Atlanta; Jerry Zuckerman, M.D., epidemiologist, division of infectious disease, Albert Einstein Medical Center, Philadelphia; April 28, 2004, Journal of the American Medical Association
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