It is an
endemic condition in our area. It is not uncommon to receive a patient with
cutaneous anthrax. In this case, both gram stain and colture were done and turned
positive for Bacillus anthracis.
The case I present
to you has no occupational risks: he is not a butcher, or a farmer. Actually he
is a mason. At the inoculation site there was no previous wound. We must take
into consideration the flies as a possible vector for the spores.
As you can
appreciate through the photos a central black eschar has already appeared, and
that is very typical of the disease.
Anthrax, a
zoonotic disease caused by Bacillus anthracis, occurs in domesticated and wild
animals, primarily herbivores, including goats, sheep, cattle, horses, and
swine. Humans usually become infected by contact with infected animals or
contaminated animal products, most commonly via the cutaneous route (95% of the
cases), and only rarely via the respiratory or gastrointestinal routes.
Direct
contact with contaminated material leads to cutaneous disease, and ingestion of
infected meat leads to oropharyngeal or gastrointestinal forms of anthrax (in
March we had an outbreak of gastrointestinal anthrax in Kakamega).
Inhalation
of a sufficient quantity of spores, usually seen only during generation of
aerosols in an enclosed space associated with processing contaminated wool or
hair, leads to inhalational anthrax. Under
natural conditions, inhalational anthrax is rare.
The
treatment of choice is Ciprofloxacin 500 mg BD for 7-10 days or Doxycycline 100
mg BD for 60 days in case of inhalation.
SOURCES
1.
Hugh-Jones ME, de Vos V. Anthrax and wildlife. Rev Sci Tech.
2002;21:359–383.
2. Bales
ME, Dannenberg AL, Brachman PS, Kaufmann AF, Klatsky PC, Ashford DA. Epidemiologic response to anthrax outbreaks: field investigations,
1950–2001. Emerg Infect Dis. 2002;8:1163–1174.
3. Woods
CW, Ospanov K, Myrzabekov A, Favorov M, Plikaytis B, Ashford DA. Risk factors
for human anthrax among contacts of anthrax-infected livestock in Kazakhstan. Am
J Trop Med Hyg. 2004;71:48–52.
4. Dragon
DC, Bader DE, Mitchell J, Wollen N.Natural
dissemination of Bacillus anthracis spores in northern Canada. Appl Environ
Microbiol. 2005;71:1610–1615.
120.
Schwartz M. Cutaneous anthrax. J Travel Med. 2002;9:333.
121.
Tutrone WD, Scheinfeld NS, Weinberg JM.Cutaneous anthrax: a concise review. Cutis. 2002;69:27–33.
Dr Bro
Giuseppe Gaido
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