Impact of traditional cutaneous scarification on anthrax lesions: A series of cases from Cubal, Angola.

OBJECTIVES: Bacillus anthracis infection is a worldwide zoonosis that affects the most vulnerable population and has a high mortality rate without treatment, especially in non-cutaneous presentations. Cutaneous scarification is still common in some regions of the world for the treatment of certain diseases as part of traditional medicine. We describe a series of cutaneus anthrax from a rural setting in Angola where cutaneus scarification is common. CASE PRESENTATION: This is a retrospective observational study describing a series of cutaneous anthrax cases from Cubal (Angola), many of whom were treated with skin scarification before admission. A total of 26 cases were diagnosed from January 2010 to December 2018. None of the cases were confirmed and eight (30.8%) were probable cases according to the Centers for the Disease Control and Prevention anthrax case definition. The median age was 11 (4.7-30.5) years, 17 (65.4%) had lesions on the head, face, or neck and 15 (57.7%) were treated with cutaneous scarification. Nine (34.6%) patients died. Traditional cutaneous scarification was significantly associated with cutaneous superinfection, respiratory, systemic involvement, and death. CONCLUSION: Our case series points to increased complications and worse outcome of cutaneous anthrax disease if treated with skin scarification.

Suspected cutaneous anthrax in rural areas.

INTRODUCTION: Cutaneous anthrax (CA), a zoonotic infectious disease is an important endemic public health disease in rural areas around the world, accounting for 95% of anthrax cases. METHODOLOGY: Fifty patients with CA were diagnosed by the presence of characteristic skin lesions and positive response to treatment. Twenty-nine patients had been treated with oral ciprofloxacin or doxycyclin for 14 days and 21 patients had been treated with intramuscular procaine penicillin for 7 days. The demographic risk factors, characteristics and treatment of CA in rural areas were evaluated. The responses to two different systemic medications were compared using χ2 test. RESULTS: Twenty-two males and 28 females were included in this study. The predominant skin lesions were black eschar, ulcer and swelling of the skin. The predilection sites were the hand and fingers. The most common route of contamination for both male and female patients was handling raw meat. The most common occupation was housewife for female patients and animal industry for male patients. The patients under ciprofloxacin or doxycyclin administration responded better to treatment; pain at lesion site and new lesions at the time of treatment were significantly lower. Secondary infection appeared to be higher in patients under procaine penicillin administration, although this difference was not statistically significant. CONCLUSIONS: In rural areas that lack medical facilities with diagnostic tools, in the presence of black eschar, rapid diagnosis and treatment of CA is essential. The administration of a broad-spectrum antibiotic is recommended as the first line treatment of suspected CA.

Recent outbreak of cutaneous anthrax in Bangladesh: clinico-demographic profile and treatment outcome of cases attended at Rajshahi Medical College Hospital.

BACKGROUND: Human cutaneous anthrax results from skin exposure to B. anthracis, primarily due to occupational exposure. Bangladesh has experienced a number of outbreaks of cutaneous anthrax in recent years. The last episode occurred from April to August, 2011 and created mass havoc due to its dreadful clinical outcome and socio-cultural consequences. We report here the clinico-demographic profile and treatment outcome of 15 cutaneous anthrax cases attended at the Dermatology Outpatient Department of Rajshahi Medical College Hospital, Bangladesh between April and August, 2011 with an aim to create awareness for early case detection and management. FINDINGS: Anthrax was suspected primarily based on cutaneous manifestations of typical non-tender ulcer with black eschar, with or without oedema, and a history of butchering, or dressing/washing of cattle/goat or their meat. Diagnosis was established by demonstration of large gram-positive rods, typically resembling B. anthracis under light microscope where possible and also by ascertaining therapeutic success. The mean age of cases was 21.4 years (ranging from 3 to 46 years), 7 (46.7%) being males and 8 (53.3%) females. The majority of cases were from lower middle socioeconomic status. Types of exposures included butchering (20%), contact with raw meat (46.7%), and live animals (33.3%). Malignant pustule was present in upper extremity, both extremities, face, and trunk at frequencies of 11 (73.3%), 2 (13.3%), 1 (6.7%) and 1 (6.7%) respectively. Eight (53.3%) patients presented with fever, 7 (46.7%) had localized oedema and 5 (33.3%) had regional lymphadenopathy. Anthrax was confirmed in 13 (86.7%) cases by demonstration of gram-positive rods. All cases were cured with 2 months oral ciprofloxacin combined with flucoxacillin for 2 weeks. CONCLUSIONS: We present the findings from this series of cases to reinforce the criteria for clinical diagnosis and to urge prompt therapeutic measures to treat cutaneous anthrax successfully to eliminate the unnecessary panic of anthrax.

Anthrax--update on diagnosis and management.

Human anthrax is difficult to contain. This is primarily because it is a zoonotic disease and the disease has never been contained in the livestock of India due to lack of adequate vaccination facilities. Animal anthrax is very common in many parts of India. The problem of anthrax is further compounded by lack of awareness on the part of village folk who unwittingly handle the hide and share the dead animal meat and this causes cutaneous and gastrointestinal forms of anthrax respectively. Hemorrhagic meningitis and pulmonary anthrax, the other forms of anthrax, carry a risk of nearly cent percent mortality. Characteristic gram positive rods abundantly found in the smear of the cerebrospinal fluid, blood etc. make diagnosis certain in most of the cases. Resistance to penicillin, the drug of choice, now being occasionally reported, may become a confounding factor while attempting successful control of the disease. Other antibiotics which are found to be very effective are doxycycline and ciprofloxacin. Fear of use of anthrax spores as a biological weapon has also given a new dimension to the problem.

Anthrax meningoencephalitis--declining trends in an uncommon but catastrophic CNS infection in rural Tamil Nadu, South India.

INTRODUCTION: Anthrax, a cattle-born zoonosis has been a serious infectious disease and its meningoencephalitic form remains a rapidly fatal illness even now. AIM: The aim of this paper is to evaluate the incidence and clinical profile of anthrax meningoencephalitis admitted to a teaching hospital predominantly serving a rural population in South India. MATERIALS AND METHODS: We made a systematic study of the case records of patients with microbiologically confirmed diagnosis of anthrax meningoencephalitis admitted over a 20-year period. We searched the internet and office records for the anthrax outbreaks and the preventive strategies in place in India. RESULTS: The admissions occurred in two clusters, four during 1992-1994 and six in 1998-2000; with no further detection unto August 2008. All patients were adult males with agriculture related occupation. Three of the 10 patients had no evidence of primary focus of infection. Majority were in coma at admission and had documented evidence of septicemia. CSF was haemorrhagic and death was the uniform outcome despite high dose intravenous penicillin G; maximum duration of hospital survival being 48 h. COMMENT: Anthrax is a rare, but catastrophic cause of meningoencephalitis. Improvement in education and life styles as well as livestock vaccination in rural areas appear to have effectively decreased the incidence of this dreaded acute zoonosis in the South Indian states of Tamilnadu and Puducherry.

Changes in ciprofloxacin utilization as shown in a large pharmacy claims database: effects of proximity to criminal anthrax exposure in October 2001.

OBJECTIVE: Identify, during the period of criminal anthrax exposures in October 2001, changes in utilization of ciprofloxacin and geographic patterns of any identified variations. DESIGN: Observational. SETTING: United States. PATIENTS: Individuals making prescription claims through a pharmacy benefits management company. INTERVENTIONS: Analysis of AdvancePCS pharmacy claims database. MAIN OUTCOME MEASURES: Percentage change in ciprofloxacin utilization for 2000 and 2001 and, by locale, for September and October 2001. RESULTS: Utilization of ciprofloxacin tablets was significantly lower in calendar year 2001 than in calendar year 2000 (median decline, 10.3%) for all months except October, when utilization of ciprofloxacin increased 9.8%. During the period of anthrax exposures (October 2001 versus September 2001), affected geographic areas, including New York (an increase of 62.5%), some other Mid-Atlantic states, and Florida (28.5%), had some of the highest percentage increases in the rate of ciprofloxacin utilization. CONCLUSION: Many Americans actively sought prophylaxis with ciprofloxacin during the course of the October 2001 anthrax attack and that utilization was higher in, but not limited to, locales with publicized cases of disease. Pharmacists, clinicians, and public health officials should note that such behavior may be expected in the event of a similar attack and should be familiar with current recommendations for the assessment and management of anthrax exposure.

The history of anthrax.

Anthrax, a potentially fatal infection, is a virulent and highly contagious disease. Descriptions of this disease begin in antiquity, with the best ancient account being by the Roman poet Virgil. During the 19th century, anthrax was the infection involved in several important medical developments. It served as the prototype for Koch's postulates regarding the causation of infectious disease. The first vaccine containing attenuated live organisms was Louis Pasteur's veterinary anthrax vaccine. In the 1900s, human inhalation anthrax occurred sporadically in the United States among textile and tanning workers, but the incidence of the illness had declined dramatically. An outbreak of inhalation anthrax occurred in Sverdlovsk near a Soviet military microbiology facility in 1979. This epidemic represented the largest documented outbreak of human inhalation anthrax in history. In October and November 2001, 22 cases of confirmed or suspected inhalation and cutaneous anthrax were reported associated with the intentional release of the organism in the United States. An additional case of cutaneous disease occurred in March of 2002.

Bacillus anthracis and antibacterial agents.

Anthrax is one of the oldest threats to humankind, and remains endemic in animals in many parts of the world. Human cases are infrequent, and some result from biological warfare. This review summarizes the current knowledge on the antibacterial activity of available antibiotics. For potential use in the most severe cases of anthrax, antibacterials need to exhibit potent in vitro activity, intracellular bioactivity, and suitable locations in lymph nodes. In animal models, it has been shown that doxycycline and fluoroquinolones are the most active compounds. There is a lack of data for animal models for macrolides and ketolides, some of them exhibiting good in vitro activity. However, systemic anthrax (inhalation or gastrointestinal) is mainly due to anthrax toxin, and therapy directed against intoxication is needed as basic treatment.

Cutaneous anthrax in Turkey: a review of 32 cases.

Anthrax, caused by the Gram-positive, rod-shaped, spore-forming bacterium Bacillus anthracis, is rarely seen in industrialized nations but is common in developing countries. Cutaneous anthrax accounts for 95% of cases and usually develops on exposed sites. This study reviews the clinical and laboratory findings of 32 patients diagnosed with cutaneous anthrax over a 4-y period in the eastern part of Turkey. All patients had a history of direct contact with infected animals. The patients, aged 6-72 y, comprised 17 (53%) males and 15 (47%) females. The most frequent localization site of skin lesions was the hands and fingers (31 patients), whereas the suborbital part of the face was invaded in 1 patient. The diagnosis was made as a result of typical clinical lesions, direct microscopy or bacterial isolation. All but 2 patients were successfully treated with penicillin; these other 2 patients were treated initially with sulbactam-ampicillin. All patients, including the patient with suborbital anthrax, were cured.

Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001.

Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. This report updates previous findings, provides new information on case investigations in two additional areas, presents the susceptibility patterns of Bacillus anthracis isolates, and provides interim recommendations for managing potential threats and exposures and for treating anthrax.

Human anthrax in India: urgent need for effective prevention.

Anthrax is a zoonotic illness caused by Bacillus anthracis. Sporadic cases continue to be reported from many parts of the world. From India, both sporadic cases and outbreaks are being reported regularly. The Union Territory of Pondicherry (a former French colony) lies on the coast of Bay of Bengal, where the incidence of anthrax is on the rise with 28 cases being detected in the year 1999 and 2000 alone. So far, about 34 human cases have been encountered in this region. Recently, an increase in the number of anthrax cases has been noted in veterinary and human practice in this area. Most cases have occurred in agricultural labourers who gave history of handling animal meat or skin of infected animals. The meningitic form of the disease has a very bad prognosis. Patients with this form of disease died despite treatment with high dose penicillin. The typical bacilli were seen in the CSF in all cases of anthrax meningitis and was diagnostic of the condition. The cutaneous form of illness had a benign course and responded favourably to penicillin treatment. Awareness among clinicians and mandatory reporting of cases to public health departments along with public education will help control morbidity and mortality due to anthrax. Effective immunization of animals is the other important control measure for anthrax.

The ecology of anthrax spores: tough but not invincible.

Bacillus anthracis is the causative agent of anthrax, a serious and often fatal disease of wild and domestic animals. Central to the persistence of anthrax in an area is the ability of B. anthracis to form long-lasting, highly resistant spores. Understanding the ecology of anthrax spores is essential if one hopes to control epidemics. Studies on the ecology of anthrax have found a correlation between the disease and specific soil factors, such as alkaline pH, high moisture, and high organic content. Researchers initially suggested that these factors influenced vegetative anthrax bacilli. However, subsequent research has shown that vegetative cells of B. anthracis have very specific nutrient and physiological requirements and are unlikely to survive outside a host. Review of the properties of spores of B. anthracis and other Bacillus species suggests that the specific soil factors linked to epidemic areas reflect important environmental conditions that aid the anthrax spores in causing epidemics. Specifically, high levels of calcium in the soil may help to maintain spore vitality for prolonged periods, thereby increasing the chance of spores encountering and infecting a new host. Cycles of runoff and evaporation may collect spores dispersed from previous epidemics into storage areas, thereby concentrating them. Uptake of large doses of viable spores from storage areas by susceptible animals, via altered feeding or breeding behavior, may then allow the bacterium to establish infection and cause a new epidemic. Literature search for this review was done by scanning the Life Sciences Collection 1982-1994 using the keywords "anthrax" and "calcium and spore."

Carbunco cutáneo: revisión de casuística en el Hospital de Enfermedades Infecciosas de Santiago, entre 1975-1993 / Cutaneous anthrax: case review at the Hospital de Enfermedades Infecciosas at Santiago, between 1975-1993

Se revisan 10 casos de carbunco cutáneo internados en el Hospital de Enfermedades Infecciosas profesor Dr. Lucio Cordova entre los años 1975 a 1993. En todos los pacientes las manifestaciones clínicas fueron la base del diagnóstico lo que unido al antecedente epidemiológico, evolución del cuadro clínico y cultivos bacteriológicos, hicieron que el reconocimiento de esta enfermedad fuera relativamente fácil. Se describieron las características clínicas, de laboratorio y los buenos resultados del tratamiento con penicilina sin que se produjeran casos fatales