If your nose is running, you probably don't have anthrax

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CDC site: www.bt.cdc.gov/

By Daniel Q. Haney ~ The Associated Press

Doctors have a new clue to help sort out whether people with aches and coughs have the ominous first signs of inhaled anthrax or ordinary colds and flu: Anthrax victims don't have runny noses.

In general, the first symptoms of inhaled anthrax are the same as the flu and other wintertime viruses -- fever, ache, cough, no energy. As a result, some worry that doctors will prescribe lots of anthrax-killing antibiotics -- which do nothing for colds and flu -- just to make sure they don't miss a case of anthrax in its early, treatable stage.

But none of the 10 cases of inhaled anthrax so far have started with nasal congestion or runny nose. Those symptoms, of course, are common in flu and many other viruses that cause wintertime respiratory ills. So asking about it can help doctors rule out anthrax.

The possible overuse of antibiotics worries officials at the Centers for Disease Control and Prevention, which last week offered some guidance for doctors who wonder how to tell which is which.

"We will do everything we can to help clinicians sort this out," promised Dr. Julie Gerberding.

No test will reveal anthrax exposure or predict who might develop anthrax in the near future. Nasal swabs, if given soon enough, can help show whether anthrax was present in a particular location, but they do not tell doctors anything about an individual's risk.

So far, the single most important information is the patient's job. Doctors should be suspicious if patients are postal workers or handle mail, especially in areas where anthrax has been found.

"I can't emphasize enough the importance of the clinical history of the occupation and the environment in which the person works," Gerberding said.

White cell counts also may be elevated in anthrax cases, Gerberding noted. These readings are likely to be normal or below with viral infections.

However, no single sign or symptom can reveal whether someone has early inhaled anthrax. Antibody levels eventually rise, but that occurs late in the infection, after treatment should have already begun.

"We don't want everybody coming in with the flu to get an antibiotic," Gerberding said.

Dr. Frederick Hayden, a flu specialist at the University of Virginia, estimated that 60 percent of flu cases involve runny noses, and the figures are even higher for most other common respiratory viruses.

"The dilemma will be sorting out the extremely rare case of inhalation anthrax from this massive background of respiratory viral infections," he said.

Some doctors have promoted the use of flu shots this year because they will reduce the frequency of symptoms that can be confused with anthrax. However, many are skeptical about this reasoning. They note that perhaps 90 percent of wintertime flu-like illnesses are cause by neither the flu nor anthrax. So even those who get flu shots may still come down with flu-like symptoms from other viruses.

"We really don't want to sell the idea that if you get vaccinated against the flu ... and if you do develop a flu-like illness, then you ought to be more worried about anthrax," said Dr. Keiji Sukuda, a CDC flu expert.

The best reason to get a flu shot, he said, is to avoid the flu.