Clinical Findings in Children with Cutaneous Anthrax in Eastern Turkey

Abstract

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.

The evaluation of clinical and laboratory findings of 63 inpatient with cutaneous anthrax: Characteristics of cutaneous anthrax in Turkey

“…Olguların tamamı DŞ olduğu için sporlar büyük olasılıkla direk temasla bulaşmıştı. Ancak bazı hastalarda kesinlikle temas öyküsüne rastlanmadığı için, başka 17 . Ülkemizde erişkin hastaların çoğunlukta olduğu olgu bildirimlerinde el ve el parmaklarının en sık etkilenen uzuvlar olduğu bildirilmiştir 2,5,18 .…”

“…Hastalığın gram boyama ve kültür dışında spesifik laboratuvar bulgusu yoktur. Bazı çalışmalarda CRP, sedimantasyon ve beyaz kan hücresi değerleri genellikle yüksek bulunmuştur 2,17,22 . Bizim çalışmamızda da benzer şekilde beyaz kan hücresi %30,5 hastada normalden yüksekti (normal değer 3-10x10 9 /L).…”

“…Türkiye'den bildirilen çalışmalarda DŞ erkek hastalarda daha çok saptanmıştır 2,7,20 . Çocuk hastalardan oluşan bir çalışmada yine erkek baskınlığı ön plandaydı 17 . Ancak bizim çalışmamızda kadınlarda DŞ daha sık görüldü.…”

Naturally Occurring Cutaneous Anthrax: Antibiotic Treatment and Outcome

“…Microbiologic procedures (Gram stain and culture) can confirm the diagnosis [3,7,14,15]. The differential diagnosis of CA includes insect bites, molluscum contagiosum, cellulitis, ecthyma, milker's nodule, plague, tularemia, aspergillosis, mucormycosis, cutaneous leishmaniasis, cutaneous tuberculosis, leprosy, rat bite fever, scrub typhus, rickettsial spotted fevers and ecthyma gangrenosum.…”

“…Tissue culture from skin lesions is a diagnostic procedure but may not be useful for diagnosis in most cases because positive culture rates do not exceed 60-65%, probably owing to the use of antimicrobial therapy or the microbicidal activity of the local antagonistic skin flora [17]. Microbiological confirmation rates range from 15.4 to 67.5% by Gram staining and from 12.9 to 53.8% by culture in several studies [3,5,8,14,15,16]. The rates of Gram staining and culture positivity were low (20 and 16.1%, respectively) because of prior antibiotic use before admission in approximately one fourth of the patients in this study.…”