U.S. health officials say it was probably Kathy Nguyen's delay in seeking treatment - and not any new, more antibiotic-resistant strain of anthrax - that prevented doctors from saving the New York hospital worker's life.
Nguyen, 61, was already gravely ill when she reached New York's Lenox Hill Hospital, where she died Wednesday after three days of aggressive antibiotic treatment, becoming the fourth fatality from inhalation anthrax since the attacks began claiming victims a month ago.
Medical investigators have not completed their scrutiny of the anthrax that killed Nguyen. But they said they have found no evidence that the strain was any more resistant to antibiotics than the anthrax in any of the earlier incidents.
In that respect "they are completely identical," said Dr. Julie Gerberding, acting deputy director of the National Center for Infectious Diseases. "We cannot account for the patient's death on the basis of antibiotic resistance. The more likely explanation is that she did not receive early treatment."
Elsewhere yesterday, authorities reported that new traces of anthrax have turned up in four Food and Drug Administration mailrooms in suburban Maryland; in a postal facility in Kansas City, Mo.; and in a U.S. Embassy mailbag in Lithuania.
Abundance of caution
In Washington, the city sought to calm anthrax fears by urging mailroom employees at more than 4,000 downtown businesses to stop taking antibiotics if private testing has found their work spaces free of anthrax.
But thousands more - people who worked at the contaminated Brentwood mail center and two smaller post offices, and still others in private mailrooms that receive mail from Brentwood and sort it with machines - were told to continue the medication.
City officials said they were taking a more conservative approach for these workers, in part out of an abundance of caution. The Centers for Disease Control and Prevention said yesterday that workers at facilities where only trace amounts of anthrax were found could discontinue antibiotics, but district officials declined to endorse that recommendation.
"We really don't know yet what the safe level of anthrax is," said Dr. Ivan Walks, the district's chief health officer. "It's kind of like being a little bit pregnant."
No obvious ties
Hundreds of investigators were trying yesterday to identify the source of Nguyen's infection. A hospital stockroom employee, she had no obvious ties to the mail system, the government or the news media targeted by earlier attacks. Her death has authorities worried that the anthrax attacks may have begun, somehow, to reach a new category of victims.
Only one other victim had an infection as mysterious as Nguyen's. In New Jersey, a 51-year-old bookkeeper at an accounting firm is recovering from the less serious cutaneous anthrax.
She told authorities that she did not recall opening any suspicious mail. But investigators say it's possible she contracted the skin infection from mail tainted during processing at a nearby Postal Service center. The center handled the anthrax-laden letters mailed to newsrooms in New York and a Senate office building in Washington.
"The risk from mail is not zero. It is very low, but it's not zero," said Dr. Jeffrey P. Koplan, director of the CDC.
One less clue
In a bit of good news yesterday, New York Mayor Rudolph W. Giuliani said that preliminary tests on a suspicious skin lesion reported by one of Nguyen's co-workers at the Manhattan Eye, Ear and Throat Hospital was negative for anthrax.
But that also left investigators with one less clue to where or how Nguyen might have inhaled a lethal dose of anthrax spores. Preliminary tests of the hospital and Nguyen's home in the Bronx have turned up negative.
"We are reviewing the routes that mail might have traveled to reach her," Gerberding said. "So far we have found no clues to suggest that the mail or the mail handling was the cause of her exposure."
She said it appeared unlikely that Nguyen was dosed with anthrax in some kind of public release because no similar cases have surfaced.
"If an individual was exposed in a public setting one might expect additional cases of the disease," she said. "It is to my mind somewhat reassuring that this was not something that posed a broader threat."
Investigators tried to reconstruct Nguyen's life before she became ill - work made more difficult because the Vietnamese immigrant lived alone and was never able to be interviewed. They spoke with her neighbors and collected environmental samples everywhere she might have gone. Anthrax spores were found in a bag that held the clothing and shoes Nguyen wore to the hospital. More tests are being done, but Gerberding said the contaminated clothing "doesn't tell me anything."
"If someone stepped on an anthrax spore and it stuck to their tennis shoe, it would probably stay there for a long time. It's not that great a clue," she said.
16 confirmed cases
Nationally, the CDC has confirmed 16 cases of anthrax disease since the attacks began. Ten have been inhalation cases, of which four have been fatal. Six have been the more easily treated skin infections. All those patients have recovered, or are recovering, the CDC said. The CDC continues to monitor six suspected cases of cutaneous anthrax.
The search for possible anthrax contamination continued at what amounts to a tiny fraction of the nation's 38,000 postal facilities.
Azeezaly S. Jaffer, the Postal Service's vice president for communications, said yesterday that testing has been completed at 64 of the 230 postal installations so far scheduled for environmental sweeps. Most of the facilities are in the Eastern United States, with some random checks across the country.
Anthrax has been found so far at eight facilities - three in the Washington area; two in New Jersey; and one each in New York City, Indianapolis and Kansas City. That is in addition to the government mailrooms, Capitol Hill offices, and New York and Florida news media buildings where the bacteria have turned up.
4 FDA sites in Maryland
The Food and Drug Administration said yesterday that four FDA mailrooms, in Rockville, Gaithersburg and two other suburban Maryland sites, were positive for anthrax in preliminary tests. The agency closed all of the facilities until they can be cleaned.
Preliminary tests Wednesday found anthrax spores in two employee trash bags at a specialized postal facility in Kansas City. The center was closed for further tests and a cleanup. About 170 employees were told to begin taking antibiotics.
In Vilnius, Lithuania, a lab confirmed yesterday that traces of anthrax were found in at least one mailbag used by the U.S. Embassy in the former Soviet Baltic republic, marking the first known appearance in Europe since the attacks began.
Sun staff writer Ellen Gamerman and wire services contributed to this article.Copyright © 2014, The Baltimore Sun