[drjoe]

It is certainly possible that anthrax cases have been missed in the past but I don't think that this is a reasonable explanation for these cases. While it would not be likely that an old lady dying of pneumonia would trigger an autopsy by a coroner or medical examiner, it is likely that for every person dying unattended at home many more would be admitted to a hospital for their terminal illness. Probably, in the United States, more dying in a hospital than dying at home. If indeed they made it to the hospital, then they would, as in the case in New York and - presumably - this case would have had a culture. While not making a definitive diagnosis from a culture or sputum gram stain, the finding of bacilli and not the far more common cocci would set off alarm bells. As a pathologist practicing for over thirty years in the northeast - both as a hospital pathologist and forensic pathologist I have seen a grand total of ZERO cases of clinical anthrax. This applies to cases diagnosed premortem and cases of unexplained deaths referred to the medical examiner for autopsy and definitive diagnosis. Zero, zip, zilch. I do not think, therefor, that we are now seeing cases that have been previously overlooked.