Abstract
BackgroundIn 2000, Ringertz et al described the first case of systemic anthrax caused by injecting heroin contaminated with anthrax. In 2008, there were 574 drug related deaths in Scotland, of which 336 were associated with heroin and or morphine. We report a rare case of septicaemic anthrax caused by injecting heroin contaminated with anthrax in Scotland.Case PresentationA 32 year old intravenous drug user (IVDU), presented with a 12 hour history of increasing purulent discharge from a chronic sinus in his left groin. He had a tachycardia, pyrexia, leukocytosis and an elevated C-reactive protein (CRP). He was treated with Vancomycin, Clindamycin, Ciprofloxacin, Gentamicin and Metronidazole. Blood cultures grew Bacillus anthracis within 24 hours of presentation. He had a computed tomography (CT) scan and magnetic resonance imagining (MRI) of his abdomen, pelvis and thighs performed. These showed inflammatory change relating to the iliopsoas and an area of necrosis in the adductor magnus.He underwent an exploration of his left thigh. This revealed chronically indurated subcutaneous tissues with no evidence of a collection or necrotic muscle. Treatment with Vancomycin, Ciprofloxacin and Clindamycin continued for 14 days. Negative Pressure Wound Therapy (NPWT) device was applied utilising the Venturi™ wound sealing kit. Following 4 weeks of treatment, the wound dimensions had reduced by 77%.ConclusionsAlthough systemic anthrax infection is rare, it should be considered when faced with severe cutaneous infection in IVDU patients. This case shows that patients with significant bacteraemia may present with no signs of haemodynamic compromise. Prompt recognition and treatment with high dose IV antimicrobial therapy increases the likelihood of survival. The use of simple wound therapy adjuncts such as NPWT can give excellent wound healing results.
Highlights
In 2000, Ringertz et al described the first case of systemic anthrax caused by injecting heroin contaminated with anthrax
Conclusions: systemic anthrax infection is rare, it should be considered when faced with severe cutaneous infection in intravenous drug user (IVDU) patients
We present an interesting case of septicaemic anthrax, in a patient with no evidence of septic shock, caused by injecting heroin contaminated with anthrax in the UK
Summary
We present an interesting case of septicaemic anthrax in an intravenous drug user, who despite having B. anthracis bacteraemia and severe cutaneous infection, displayed no evidence of septic shock and made an uneventful recovery following IV antibiotic therapy and surgical debridement. He suggested using ciprofloxacin 400 mg IV combined with a penicillin for inhalation and severe cutaneous anthrax infection [21] His recommendations were based on consensus guidelines published by Iglesby et al The efficacy of ciprofloxacin in anthrax had been poorly studied in humans, in animal models excellent recovery has been demonstrated despite the lack of an immune response [22]. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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