Palpebral anthrax, a rare though important condition in villagers: A case report and literature review.

The aerobic Gram-positive rod Bacillus anthracis can cause potentially lethal diseases affecting different organs. Localized eyelid inflammation is a rare presentation of cutaneous anthrax. This case report involves two patients with palpebral anthrax admitted to the oculoplastic ward of Feiz Eye Hospital, Isfahan, Iran. The patients had a history of close contact with animals. Clinical presentation included palpebral swelling and necrosis of the eyelids in both cases. The patients first underwent an appropriate antibiotic regimen, and biopsy specimens were collected from their necrotic tissues. They were discharged after complete healing and followed up to manage possible complications. Cicatricial ectropion developed in both cases during healing. Reconstructive surgery was scheduled for both cases 6 months after their discharge.

A serious case of anthrax associated with compartment syndrome.

Compartment syndrome linked to skin anthrax is a rare complication that may develop and it should be noted that the disease may progress in spite of medical drug treatment. Our case was a farmer who was exposed after slaughtering a dead animal, a time delay for treatment hided this history and then developed compartment syndrome. In anthrax cases with delayed treatment and aggressive progression, circulation in the extremities should be carefully noted. We believe that the cases with compartment syndrome progressing in spite of medical drug treatment may be assessed for fasciotomy as a treatment approach.

Anthrax of the lower lip.

Anthrax of the oral cavity and oropharynx is well known, whereas anthrax of the lips is very rare. We present a case of anthrax of the lower lip in a 57-year-old man. The infection was characterized by a wide, black eschar, surrounded by vesicles, crusts, and erythematous-edematous halo, with submandibular and laterocervical lymphadenopathy. The oral cavity, oropharynx, and tonsils were normal. Laboratory examinations revealed leukocytosis and increased inflammatory markers. Otolaryngologic, gastrointestinal, lung, and neurologic examinations were negative. The patient was successfully treated with oral ciprofloxacin. Although rare, anthrax should be considered in the differential clinical diagnosis in patients returning from areas where this disease is endemic.

Debridement increases survival in a mouse model of subcutaneous anthrax.

Anthrax is caused by infection with Bacillus anthracis, a spore-forming gram-positive bacterium. A major virulence factor for B. anthracis is an immunomodulatory tripartite exotoxin that has been reported to alter immune cell chemotaxis and activation. It has been proposed that B. anthracis infections initiate through entry of spores into the regional draining lymph nodes where they germinate, grow, and disseminate systemically via the efferent lymphatics. If this model holds true, it would be predicted that surgical removal of infected tissues, debridement, would have little effect on the systemic dissemination of bacteria. This model was tested through the development of a mouse debridement model. It was found that removal of the site of subcutaneous infection in the ear increased the likelihood of survival and reduced the quantity of spores in the draining cervical lymph nodes (cLN). At the time of debridement 12 hours post-injection measurable levels of exotoxins were present in the ear, cLN, and serum, yet leukocytes within the cLN were activated; countering the concept that exotoxins inhibit the early inflammatory response to promote bacterial growth. We conclude that the initial entry of spores into the draining lymph node of cutaneous infections alone is not sufficient to cause systemic disease and that debridement should be considered as an adjunct to antibiotic therapy.

Subcutaneous anthrax in three intravenous drug users: a new clinical diagnosis.

Anthrax is extremely rare in the western world but is endemic to areas of south and central Asia. In early 2010 an outbreak was identified in heroin-injecting intravenous drug users in the United Kingdom and Europe. Afghanistan is currently the principal source of heroin which reaches the United Kingdom. When anthrax occurs, cutaneous disease accounts for over 95% of cases. At least 47 cases with 13 deaths have been confirmed so far. We present three cases presenting during this time with marked swelling, one resulting in compartment syndrome but all with an absence of the expected cutaneous appearances. We suggest that rather than cutaneous anthrax, these patients represent a new subcutaneous presentation of anthrax.

Clinical findings in children with cutaneous anthrax in eastern Turkey.

Anthrax is a zoonosis produced by Bacillus anthracis. The aim of this study was to evaluate the clinical findings, therapy, and outcome in children with cutaneous anthrax (CA). Data on age, gender, occupation, clinical symptoms and findings, location and type of lesions, clinical history, laboratory findings, treatment, and outcome were recorded from patients' medical records, retrospectively. The study included 65 patients between 1 month and 18 years old (9.0±4.0 years), 37 patients (56.9%) were male and 28 (43.1%) were female. Most of the patients (89.1%) were admitted in summer and autumn (p<0.001). Of the 65 patients, 20 patients (30.8%) had received antibiotherapy before admission to our hospital. All patients except one had a contact history with infected animals. A 1-month-old patient had a contact history with his mother who had CA. On clinical examination, anthrax edema was noted in 36 (55.3%) patients, anthrax pustule in 27 (41.5%), and anthrax edema and anthrax pustule in two (3%) patients. Gram staining and culture was positive for B. anthracis in 35 (53.8%) patients, and only Gram staining was positive in 10 (15.4%) patients. In the remaining 20 (30.8%) patients, the diagnosis was made by clinical findings. Because the anthrax outbreak in Turkey was associated with slaughtering or milking of ill cows, sheep, or goats, and handling raw meat without taking any protective measures, persons in the community must be educated about using personal protective equipment during slaughtering of animals and handling of meat and skins.

Fiebre y pústulas en paciente con pancreatitis aguda grave / No disponible

No disponible

[A recent case of palpebral anthrax]. / Charbon palpébral: à propos d'un cas.

Anthrax disease is an acute infection caused by Bacillus anthracis. It appears in three forms: pulmonary, intestinal, and cutaneous, whose palpebral location is rare but serious. The authors report the case of a 38-year-old patient who presented 3 weeks after the appearance of an upper and lower palpebral tumefaction. Questioning revealed that he was a cattle breeder. The ophthalmologic examination of the right eye brought out serosanguineous blisters, an edema, and necrotic scabs involving the upper and lower eyelids, preventing any clinical examination of the ocular bulb. The bacteriological sample was negative. The patient progressed well when treated with G penicillin, but retained a cicatricial ectropion. Anthrax is receiving increasing interest given how difficult it is to diagnose, the severe prognosis, and the possibility of its dissemination in bacteriological warfare or bioterrorism.

Endemic gastrointestinal anthrax in 1960s Lebanon: clinical manifestations and surgical findings.

Anthrax is an ancient disease caused by the gram-positive Bacillus anthracis; recently, it has gained much attention because of its potential use in biologic warfare. Anthrax infection occurs in three forms: cutaneous, inhalational, and gastrointestinal. The last type results from ingestion of poorly cooked contaminated meat. Intestinal anthrax was widely known in Lebanon in the 1960s, when a series of >100 cases were observed in the Bekaa Valley. We describe some of these cases, introduce the concept of the surgical management of advanced intestinal anthrax, and describe some of the approaches for treatment.

Cutaneous anthrax of the hand and its reconstruction with a reverse-flow radial forearm flap.

Bacillus anthracis infection can lead to necrosis in tissues and may manifest as a fatal disease in human beings. The authors present a patient with a large area of skin necrosis on the dorsum of the hand that was reconstructed with a reverse flow-through radial forearm flap, and they discuss the relevant literature. To the authors' knowledge, this is the first published report of such extensive necrosis resulting from anthrax limited to the extensor retinaculum of the hand.

Bacillus anthracis as an agent of bioterrorism: a review emphasizing surgical treatment.

OBJECTIVE: To familiarize surgeons with the specific complications of cutaneous, gastrointestinal, inhalation, and systemic infection with Bacillus Anthracis, which may require surgical treatment. SUMMARY BACKGROUND DATA: The recent cases of intentional exposure to Bacillus Anthracis in the United States make familiarity with the basic microbiology, clinical manifestations, diagnosis, treatment, and control of this disease essential if mortality and morbidity is to be minimized, particularly following mass exposure. Although the treatment of Bacillus Anthracis infection is primarily medical, there are specific surgical complications with which the surgeon should be familiar. METHODS: A review of the literature was undertaken, utilizing electronic databases on infection with Bacillus Anthracis, as well as consultation with experts in this field. Emphasis was placed on the diagnosis and treatment of complications of infection that might require surgical intervention. RESULTS: Cutaneous anthrax infection results in eschar formation and massive soft tissue edema. When involving the extremities, increased compartment pressure requiring fasciotomy may result. Primary infection of the gastrointestinal tract may result in oropharyngeal edema and respiratory compromise requiring a surgical airway. Direct involvement of the lower gastrointestinal tract can result in intestinal ulceration, necrosis, bleeding, and perforation, which would require surgical exploration and resection of affected segments. Systemic sepsis, most often associated with inhalation anthrax, can cause massive ascites, electrolyte derangements, and profound shock requiring aggressive fluid resuscitation and careful hemodynamic monitoring and respiratory support. Systemic anthrax infection can also lead to gastrointestinal involvement by hematogenous dissemination, resulting in complications and requiring surgical management similar to direct gastrointestinal infection. CONCLUSIONS: Cutaneous, gastrointestinal, inhalation and systemic infection with Bacillus Anthracis can result in complications which would require familiarity with the pathogenesis and manifestations of this disease in order to recognize and treat promptly and successfully by surgical intervention.

Ulnar nerve lesion due to cutaneous anthrax.

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax is most common in agricultural regions, where it occurs in animals. It can also infect humans. Cutaneous anthrax infections occur when the bacterium enters a cut or abrasion on the skin. A case of cutaneous anthrax infection of the arm is presented. The patient needed to undergo a skin graft. He subsequently developed an ulnar nerve lesion after severe edema in his arm and hand.

Surgical management of cutaneous anthrax.

Cutaneous anthrax in humans is a very rare disease caused by Bacillus anthracis. Humans become infected with this spore-forming bacterium when they come into contact with an infected animal. The disease usually develops on exposed sites like the hands and the face. The authors present 4 patients with cutaneous anthrax: 2 of the hands and 2 of the eyelids. All patients needed plastic surgical help via skin grafting after excision of the black eschar. No complications occurred after surgery. Because they are so rare in Europe and the United States, sporadic cases of anthrax are easily overlooked because the diagnosis often is not considered. Cutaneous anthrax should be considered in any patient with a painless ulcer or black eschar who has a history of exposure to animals.