Hunt for Source in N.Y. Anthrax Death Falters

The mysterious anthrax death of a New York woman with no known connection to tainted letters got more puzzling Thursday as two possible leads to the source of her infection proved false and investigators conceded their search had yielded “no clues.”

More anthrax hot spots turned up Thursday, including the westernmost point yet: a Kansas City, Mo., postal facility that handles collectible stamps. The facility, which does not process mail for the general public, had received mail from a contaminated postal hub in the nation’s capital.

The inquiry, if anything, seemed to take a step backward Thursday as investigators scrambled to solve the case of Kathy T. Nguyen, a stockroom worker at a Manhattan hospital who died of inhalation anthrax Wednesday.

Health officials said tests so far indicate that the bacteria that killed Nguyen are “indistinguishable” from the other known anthrax infections. Health officials had been concerned that Nguyen might have inhaled a different strain when she did not respond to the antibiotics that have been successful in other cases. They now believe she sought treatment too late.

Anthrax tests on a co-worker of Nguyen who had a skin lesion came back negative, New York Mayor Rudolph W. Giuliani announced. One final test was still needed, but Giuliani said it was unlikely to be a case of anthrax.

Additional tests on the dead woman’s clothing, which had initially tested positive for the presence of anthrax spores, also were negative.

Investigators, who have found no sign of anthrax at Nguyen’s workplace or home, are searching for any clue that might help them get to the bottom of what caused the 61-year-old’s death.

“We have no conclusive evidence at this point in time. I wish we did, but we don’t,” Health and Human Services Secretary Tommy G. Thompson said Thursday.

Mail routes to Nguyen’s Bronx apartment building and the Manhattan Eye, Ear and Throat Hospital also appeared to be clean of anthrax contamination, further adding to uncertainty about how the Vietnamese immigrant, who lived alone and led a quiet life, could have contracted the deadly disease.

“We are reviewing the routes that mail might have traveled to reach her in her home or in her mail room, but so far we have found no clues to suggest that the mail or mail handling per se was the source of her exposure,” said Dr. Julie Gerberding of the Centers for Disease Control and Prevention in Atlanta.

She said the fact that there had not been a widespread outbreak in New York, where Nguyen remains the only inhalation anthrax case, seemed a good sign.

More Contamination at Huge Mail Facility

“If an individual was exposed in a public setting, one might expect additional cases of disease,” she said. “The fact that those have not been seen is somewhat, at least in my mind, reassuring that this was not something that posed a broader health risk in a public environment.”

At the same time, however, officials continued to maintain that inhalation anthrax could not be caused by a letter that merely came in contact with a contaminated object.

In New York, at the huge Morgan Processing and Distribution Center, which processes 12.5 million pieces of mail daily, contamination was found Thursday on six additional mail sorting machines. Previously, four machines there were found to be contaminated.

Fourteen of the 16 confirmed cases of anthrax to date have direct ties either to the media or the postal system.

The White House said Thursday that the mystery about how Nguyen contracted the lethal bacteria continued to be a “matter of concern.”

“There’s a sense of we need to find out how this happened, what took place,” said Bush spokesman Ari Fleischer.

Four weeks after a Florida tabloid employee died of inhalation anthrax, investigators appeared no closer to finding the source of the lethal bacteria or who launched the attack by mail.

Photo editor Bob Stevens, 63, who died Oct. 5, marked the first anthrax fatality in the U.S. since 1976. The significance of Stevens’ case was not immediately apparent, though, with officials initially believing the avid outdoorsmen had contracted it from a natural source, possibly a stream or rural area of North Carolina, where he had visited.

Since then, anthrax infections have been confirmed in 15 other people, killing Nguyen and two Washington postal employees. And authorities have discovered three anthrax-laced letters, to Senate Majority Leader Tom Daschle (D-S.D.), NBC News anchor Tom Brokaw and the New York Post.

In recent weeks, health officials and investigators have repeatedly had to revise their beliefs about how anthrax spores could spread and who was at risk. The circle of contamination spread as far as embassy mail rooms in Europe and South America, and additional mail workers in New Jersey and Washington fell ill.

In Karachi, Pakistan, suspicious powder found in an envelope hand-delivered to the Daily Jang newspaper offices last week has tested positive for the presence of anthrax spores, Mehmood Sham, the newspaper’s editor, said today.

Including Stevens, 10 people have been infected with the inhaled form of the disease and six others have skin anthrax infections. An additional five people are highly suspected to be suffering from skin anthrax; health officials said that because they are taking antibiotics, their cases may never be confirmed.

Health officials said they are reassured that, despite the discovery of anthrax traces at a growing number of locations, no additional confirmed cases had emerged this week.

In Kansas City, a clearinghouse for first-day stamps remained closed Thursday after anthrax contamination was found in trash bags containing mail that had come from the Brentwood facility in Washington, D.C. Nearly 200 employees at the Kansas City facility were given anti-anthrax drugs. Like a postal facility in Indianapolis that tested positive earlier in the week, the Kansas City facility was one of the first tested because officials knew it had received items from Brentwood, where the Daschle letter was processed.

Traces of anthrax also were found in four buildings at the Rockville, Md., headquarters of the U.S. Food and Drug Administration, prompting officials to shut down all mail rooms there. More than 20 anthrax hot spots already had been detected in the Washington area.

Meanwhile, the CDC said it has made good progress in understanding how anthrax acts medically. It is a disease few in the medical community had experience diagnosing or treating.

With the flu season beginning, federal health officials have been working hard to establish guidelines for physicians who may face the challenge of distinguishing ordinary flu symptoms from lethal inhalation anthrax. A key question, CDC officials said, will be determining a person’s occupation. For example, an illness in a postal worker would be cause for heightened scrutiny.

From the 10 cases they have observed in recent weeks, officials said they are beginning to see some patterns. For instance, patients with inhalation anthrax show normal or high white blood cell counts, which indicate a bacterial infection. By contrast, patients with the flu have low white cell counts and an increase in their lymphocytes, which is consistent with a viral infection.

“This might be one of the clues that will help us distinguish between influenza and anthrax as we approach the flu season,” said Gerberding, who is acting deputy director of the CDC’s National Center for Infectious Diseases.

In addition, chest X-rays and CT scans showed abnormalities in all of the inhalation anthrax patients, although such tests should only be needed for high-risk patients.

While many symptoms of anthrax are similar to those of the flu, anthrax victims do not have runny noses and watery eyes. But, Gerberding said, “we haven’t seen a lot of patients, so we don’t want to hang our hat on any specific symptom, sign or test at this point.”

The CDC has also found that the median age of the 10 patients with inhalation anthrax was 56. These patients showed symptoms, on average, seven days after exposure. CDC Director Jeffrey Koplan said earlier this week that the illnesses represent a “unique time to make discoveries about how this disease functions. . . . It is striking that for this small number there does seem to be a disproportion in older age ranges.”

But when asked Thursday when they could provide more definitive analysis, Gerberding said it was one clinical problem she hoped not to solve because answers would require more people dying or becoming seriously ill.

“If we do our job,” she said, “we will not face that large clinical experience and will not really need to know the answer to your question.”

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Baum reported from New York, Garvey and Ornstein from Washington. Times staff writer Robert A. Rosenblatt in Washington contributed to this report.