October 24, 2001

BALTIMORE (AP) - A postal worker is sent home from a hospital after doctors tell him he has the flu. The next day he returns and dies of anthrax.

The death of 47-year-old Joseph P. Curseen has underscored the difficulty - and the life-and-death importance - of distinguishing between the inhaled form of anthrax and the flu, especially with the peak flu season arriving.

The skin form of anthrax causes a distinctive black sore. But the inhaled form has many symptoms that mimic the flu, including fever, headache, general achiness and chest pains.

To diagnose inhaled anthrax with certainty, doctors use chest X-rays and blood cultures, which take several days to yield results.

An important step, doctors say, is checking the patient's recent history to see if he or she could have been exposed to the disease.

In Curseen's case, that may have been a fatal omission. Curseen worked at the Brentwood postal installation in Washington that probably processed the anthrax-tainted letter sent to Senate Majority Leader Tom Daschle's Capitol Hill office.

But officials at the Southern Maryland Medical Center say Curseen did not tell doctors that he was a postal worker when he first went to the hospital early Sunday after fainting in church the previous day.

When patients are admitted to the hospital, they fill out an insurance chart that includes occupation. However, doctors do not routinely look at the form because they give treatment regardless of coverage, said David Clark, a spokesman for Southern Maryland Medical Center.

In Curseen's case, a chest X-ray turned up nothing out of the ordinary, and there was nothing about the case that led doctors to suspect anthrax, the hospital said.

"Every indication was that it was stomach flu," Clark said. The medical staff, Clark said, was "following all the protocols and procedures they were told to look for."

Now, doctors are asking all patients their occupations, the spokesman said.

At a bioterrorism-preparedness forum at Johns Hopkins University for doctors, nurses and other health professionals Tuesday, Dr. Julie Casani, the state's bioterrorism coordinator, said most doctors probably have never encountered a case of anthrax.

The skin form accounts for only a case or two a year in the United States. And until this month, the inhaled form had not been seen in this country in 25 years.

But Casani said doctors are "quick studies" and have been sharing a lot of information on anthrax and other bioterrorism threats like smallpox over the past few weeks.

The state of Maryland has asked the few doctors with experience treating anthrax and smallpox to come forward to serve as advisers in cases that are under scrutiny.

As a further precaution, many health officials have urged people to help avoid confusion between flu and anthrax by getting flu shots.

"Now is the time to impress upon people to get vaccinated for the flu," said Anthony Billittier, health commissioner for New York's Erie County, "which ultimately will make our job easier when they don't get the flu and show up at the doctor's office thinking they have anthrax."

Dr. David Sullivan, assistant professor of molecular microbiology, immunology and infectious diseases at Johns Hopkins, cautioned that flu shots will eliminate only one of the many viruses and bacterial infections that can cause flu-like symptoms. The good news, he said, is that doctors who suspect a bacterial infection usually put patients on antibiotics that treat a wide range of diseases, including anthrax.

"We're used to treating with antibiotics before we know what happens, before we know the agent," Sullivan said.

Casani said this is uncharted territory for everyone. "You look under a rock and you see two more rocks," she said. "Every day we come up with new ideas as to how we could have done better the day before."