Anthrax meningoencephalitis complicated with brain abscess — A case report

Popescu, Corneliu Petru; Zaharia, Mayer; Nica, Maria; Stanciu, Delia; Moroti, Ruxandra; Benea, Șerban; Melinte, Violeta; Vasile, Teodor; Ceauşu, Emanoil; Ruță, Simona; Florescu, Simin Aysel

doi:10.1016/j.ijid.2021.05.013

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…The patient completed 21 days of triple antibiotic treatment and was discharged with no systemic or neurological signs. Despite the high fatality rate of anthrax meningitis, prompt combined administration of intravenous antibiotics during the early stage of the disease led to a successful outcome, as recently reported in a case of anthrax meningoencephalitis in Romania [ 31 ]. Patients with systemic anthrax should be frequently reassessed for the appearance of signs of meningitis (including severe headache).…”

Section: Conclusion and Discussionmentioning

confidence: 99%

An Outbreak of Human Systemic Anthrax, including One Case of Anthrax Meningitis, Occurred in Calabria Region (Italy): A Description of a Successful One Health Approach

Guastalegname

Rondinone

Lucifora

et al. 2022

Life

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In this report, three cases of human cutaneous anthrax are described, one complicated by meningitis, and all were linked to a single infected bullock. A 41-year-old male truck driver, along with two male slaughterhouse workers, 45 and 42, were hospitalized for necrotic lesions of the arm associated with edema of the limb and high fever. All three patients were involved in transporting a bullock to the slaughterhouse. Microbiological examination on the prescapular lymph node and a piece of muscle from the bullock carcass showed the presence of Bacillus anthracis. The three patients underwent a biopsy of the affected tissues, and all samples tested positive for B. anthracis DNA using PCR. Furthermore, the truck driver also complained of an intense headache, and a CSF sampling was performed, showing him positive for B. anthracis by PCR, confirming the presumptive diagnosis of meningitis. Fast diagnosis and appropriate treatment are crucial for the management of human anthrax. Cooperation between human and veterinary medicine proved successful in diagnosing and resolving three human anthrax cases, confirming the reliability of the One Health approach for the surveillance of zoonoses.

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Section: Conclusion and Discussionmentioning

confidence: 99%

An Outbreak of Human Systemic Anthrax, including One Case of Anthrax Meningitis, Occurred in Calabria Region (Italy): A Description of a Successful One Health Approach

Guastalegname

Rondinone

Lucifora

et al. 2022

Life

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“…The cerebrospinal fluid (CSF) regularly presents haemorrhagic with a marked leukocytosis and bacterial infiltration. MRI findings include leptomeningeal enhancement, vasogenic oedema 24 , abscessation 25 , multiple infarction and foremost haemorrhages 26 . In general, the inflammatory pattern in the CNS analogous to other affected organs, is of a predominantly haemorrhagic character.…”

Section: Introductionmentioning

confidence: 99%

Neuroinfectiology of an atypical anthrax-causing pathogen in wild chimpanzees

Gräßle,

Jäger,

Kirilina

et al. 2023

Preprint

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Bacillus cereusbiovaranthracis(Bcbva) is an atypical anthrax-causing bacterium, inflicting wildlife fatalities across African rainforest ecosystems. The pathogen’s virulence in one of our closest living relatives, the chimpanzee, together with human serological evidence, suggestsBcbvais zoonotic. While classicalB. anthracis-induced anthrax has been described to affect the central nervous system at a progressive disease-state, the neuroinfectiology ofBcbvais yet unknown. Here we characterised the pathogen’s neuro-invasiveness via gross pathological assessment, ultra-high resolution quantitative Magnetic Resonance Imaging and histological analysis on four brains, which were extracted from naturally deceased wild chimpanzees in Taï National Park, Côte d’Ivoire.Based on macroscopically evident pial vessel congestion and haemorrhages as well as cortical siderosis detected via MRI, we concluded thatBcbvainduced meningitis analogous toB. anthracis. Further, histological visualisation of bacteria and leukocytes in the subarachnoid space evidenced the bacterium’s capability to breach the arachnoid barrier.Bcbvawas detected in the brain parenchyma of all four cases. This indicates a higher ability to transgress the glia limitans and therefore exhibits a higher neuroinvasiveness compared toB. anthracisthat predominantly stays confined to the meninges. Heightened glial fibrillary acidic protein (GFAP) expression but little morphological gliosis suggest a rapid disease progression leading to host-death within hours to a few days after central nervous system invasion.Overall our results revealBcbva’s ability to breach blood-brain barriers which results in a pronounced neuropathogenicity.Bcbvacauses extensive damage to the meninges and the brain parenchyma, as well as rapid and massive digestion of brain extracellular matrix in chimpanzees and potentially so in humans in case of zoonotic spillover.

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Systematic Review of Hospital Treatment Outcomes for Naturally Acquired and Bioterrorism-Related Anthrax, 1880–2018

Person

Cook

Bradley

et al. 2022

Clinical Infectious Diseases

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Background Bacillus anthracis can cause anthrax and is a potential bioterrorism agent. The 2014 Centers for Disease Control and Prevention recommendations for medical countermeasures against anthrax were based on in vitro data and expert opinion. However, a century of previously uncompiled observational human data that often includes treatment and outcomes is available in the literature for analysis. Methods We reviewed treatment outcomes for patients hospitalized with anthrax. We stratified patients by meningitis status, route of infection, and systemic criteria, then analyzed survival by treatment type, including antimicrobials, antitoxin/antiserum, and steroids. Using logistic regression, we calculated odds ratios and 95% confidence intervals to compare survival between treatments. We also calculated hospital length of stay. Finally, we evaluated antimicrobial postexposure prophylaxis (PEPAbx) using data from a 1970 Russian-language article. Results We identified 965 anthrax patients reported from 1880 through 2018. After exclusions, 605 remained: 430 adults, 145 children, and 30 missing age. Survival was low for untreated patients and meningitis patients, regardless of treatment. Most patients with localized cutaneous or nonmeningitis systemic anthrax survived with 1 or more antimicrobials; patients with inhalation anthrax without meningitis fared better with at least 2. Bactericidal antimicrobials were effective for systemic anthrax; addition of a protein synthesis inhibitor(s) (PSI) to a bactericidal antimicrobial(s) did not improve survival. Likewise, addition of antitoxin/antiserum to antimicrobials did not improve survival. Mannitol improved survival for meningitis patients, but steroids did not. PEPAbx reduced risk of anthrax following exposure to B. anthracis. Conclusions Combination therapy appeared to be superior to monotherapy for inhalation anthrax without meningitis. For anthrax meningitis, neither monotherapy nor combination therapy were particularly effective; however, numbers were small. For localized cutaneous anthrax, monotherapy was sufficient. For B. anthracis exposures, PEPAbx was effective.

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Anthrax meningoencephalitis complicated with brain abscess — A case report

Cited by 6 publications

References 8 publications

An Outbreak of Human Systemic Anthrax, including One Case of Anthrax Meningitis, Occurred in Calabria Region (Italy): A Description of a Successful One Health Approach

An Outbreak of Human Systemic Anthrax, including One Case of Anthrax Meningitis, Occurred in Calabria Region (Italy): A Description of a Successful One Health Approach

Neuroinfectiology of an atypical anthrax-causing pathogen in wild chimpanzees

Systematic Review of Hospital Treatment Outcomes for Naturally Acquired and Bioterrorism-Related Anthrax, 1880–2018

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