Risk Factors for Severe Cutaneous Anthrax in a Retrospective Case Series and Use of a Clinical Algorithm to Identify Likely Meningitis and Evaluate Treatment Outcomes, Kyrgyz Republic, 2005-2012.

BACKGROUND: US Centers for Disease Control and Prevention guidelines currently recommend triple-therapy antimicrobial treatment for anthrax meningitis. In the Kyrgyz Republic, a country with endemic anthrax, cutaneous anthrax patients are routinely hospitalized and treated successfully with only monotherapy or dual therapy. Clinical algorithms have been developed to identify patients with likely anthrax meningitis based on signs and symptoms alone. We sought to retrospectively identify likely meningitis patients in the Kyrgyz Republic using a clinical algorithm and evaluate risk factors and their outcomes by type of treatment. METHODS: We conducted a retrospective chart review of cutaneous anthrax patients in the Kyrgyz Republic from 2005 through 2012. Using previous methods, we developed a highly specific algorithm to categorize patients by meningitis status. We then evaluated patient risk factors, treatments, and outcomes by disease severity and meningitis status. RESULTS: We categorized 37 of 230 cutaneous anthrax patients as likely having meningitis. All 37 likely meningitis patients survived, receiving only mono- or dual-therapy antimicrobials. We identified underlying medical conditions, such as obesity, hypertension, and chronic obstructive pulmonary disease, and tobacco and alcohol use, as potential risk factors for severe anthrax and anthrax meningitis. CONCLUSIONS: Based on our analyses, treatment of anthrax meningitis may not require 3 antimicrobials, which could impact future anthrax treatment recommendations. In addition, chronic comorbidities may increase risk for severe anthrax and anthrax meningitis. Future research should further investigate potential risk factors for severe anthrax and their impact on laboratory-confirmed meningitis and evaluate mono- and dual-therapy antimicrobial regimens for anthrax meningitis.

A case study on anthrax in an eight-month old infant at Kyrgyz Republic.

Anthrax remains a threat, especially in countries like Kyrgyzstan with developed livestock farming. Despite preventive efforts, sporadic outbreaks endure on an annual basis, transmitted from infected animals to humans. Here, we report a severe anthrax case in an 8-month-old child known to be caused when a sick calf was slaughtered in the neighborhood without proper protocols, resulting in intra-family infection. This underscores the importance of swift diagnosis, treatment, preventive measures, and awareness of zoonotic infections, animal vaccination and adherence to sanitary and veterinary protocols.

Human anthrax in Kyrgyz Republic: Epidemiology and clinical features.

BACKGROUND: Bacillus anthracis infects both humans and animals which leads to anthrax disease. The disease is still a global issue as it occurs naturally and has a potential use for bioterrorism/bio-weapons agents. This study aimed to investigate the clinical and epidemiologic features of human anthrax that has been seen in Kyrgyzstan. METHODS: This study was carried out at the Osh Regional Hospital that is located in the southern regions of Kyrgyz Republic. Medical records of patient's diagnosed with cutaneous anthrax between 2005 and 2015 were reviewed. Epidemiology and clinical features of the infection and the effectiveness of antibiotic therapy were investigated. RESULTS: Two hundred thirty four anthrax cases were reviewed. Among the patients, men in the 31-50 age group prevailed. Infection episodes that sought medical attention occurred mostly during the summer and autumn. Analysis of epidemiological data shows that anthrax contamination occurred as a result of direct contact with mainly farm animals, slaughtering, butchering and the selling of the meat. Cutaneous lesions were localized mostly in the upper extremities. Among the observed patients, a majority of the cases presented a mild form of the disease. The isolated strains of B. anthracis were mostly susceptible to amoxiclav, ofloxacin, 3rd generation of cephalosporins, doxycycline, ciprofloxacin, rifampicin, penicillin and streptomycin. A majority of the isolates were found to be resistant to ampicillin, gentamicin, chloramphenicol. CONCLUSION: Anthrax is still an endemic disease that has lead to outbreaks in the Kyrgyz Republic. The transmission of human infection is seen by direct contact with ill animals or dead animal products. The common form seen in the clinical setting is cutaneous anthrax. Future studies should focus on the surveillance and infection control measurements associated with the anthrax.