Abstract
Incidence of anthrax is diminishing in developed countries; however, it remains a public health problem in developing countries, especially those whose main source of income is farming. Charts of patients hospitalized between 1992 and 2008 in the Infectious Diseases and Clinical Microbiology Department of Ankara Numune Education and Research Hospital were reviewed. Fifty-eight cases with cutaneous anthrax were reviewed. The mean age was 49.8, and 36.2% were female. The most common professions were farmers (62%), butchers (19%), and housewives (15%). The mean incubation period was eight days. Most cases (62%) were exposed to bacteria when butchering sick animals. Eighteen patients used an antibiotic before admission to hospital (31%). The predominantly affected sites were hands (39%) and fingers (29%), followed by forearms (12%), eyelids (7%) and necks (3%). All cases initially had painless ulcers with vesicles; dissemination of the lesion was seen in 27.5% of patients. Gram stain was positive in 11 cases; culture was positive in 7 cases for Bacillus anthracis. All patients except one were discharged and treated with penicillin and/or ciprofloxacin or imipenem. One patient with a disseminated lesion on the neck died even though a steroid was used with the antibiotic. Cutaneous anthrax should be considered as a possible diagnosis in cases with a painless ulcer with vesicles, edema, and a history of exposure to animals or animal products. Despite previous antibiotic use, taking smears and cultures should be encouraged. Treatment with penicillin G or penicillin procain alone is effective for cases with cutaneous anthrax without severe edema and superinfection.
Highlights
Anthrax is a zoonotic infection that presents in 3 forms: cutaneous, inhalational, and gastrointestinal
In this study we evaluated the epidemiologic and clinical characteristics of 58 adult cutaneous anthrax cases, and reviewed the therapeutic options in the perspective of very recent Centers for Disease Control (CDC) guidelines
The most common form of the disease is cutaneous anthrax, which accounts for 95% of all cases [2]
Summary
Anthrax is a zoonotic infection that presents in 3 forms: cutaneous, inhalational, and gastrointestinal. Caused by Bacillus anthracis, anthrax is an aerobic, spore-forming, gram-positive rod found throughout the world. Anthrax is primarily an animal disease, humans can acquire anthrax by exposure to infected animals, animal products, or spores in the soil. The clue to the diagnosis of cutaneous anthrax is the history and rapid development of a painless ulcer surrounded by a zone of edema. The diagnosis is confirmed by bacteriological examination of the lesion or isolation of B. anthracis from the infected ulcer or blood by culture. In this study we evaluated the epidemiologic and clinical characteristics of 58 adult cutaneous anthrax cases, and reviewed the therapeutic options in the perspective of very recent Centers for Disease Control (CDC) guidelines
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