Cutaneous<i>Bacillus anthracis</i>Infection

Gallagher, Thomas C.; Strober, Bruce

doi:10.1056/nejmc012978

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…The eschar of anthrax, though painless, is surrounded by extensive or marked edema that is gelatinous and stretches the skin, and is often preceded by a pruritic papule. 50 , 51 Table 1 gives a summary of clinical and laboratory findings favoring or not favoring a diagnosis of scrub typhus. 23 , 25 , 28 , 52 – 58 …”

Section: Clinical Clues Favoring a Diagnosis Of Scrub Typhusmentioning

confidence: 99%

Scrub typhus: risks, diagnostic issues, and management challenges

Prakash¹

2017

RRTM

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Scrub typhus is an acute febrile illness in the “tsutsugamushi triangle”, transmitted by chiggers that can be treated effectively if detected early. Laboratory testing, including molecular and serological assays, is needed for confirming the diagnosis, especially in the absence of the pathognomonic eschar. In this review, factors that play a role in disease occurrence and clinical clues for diagnosis, in addition to risk factors contributing to disease severity, including mortality, are discussed in detail. Moreover, issues related to diagnostic assays, treatment, and mixed infections are also enumerated and described.

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Section: Clinical Clues Favoring a Diagnosis Of Scrub Typhusmentioning

confidence: 99%

Scrub typhus: risks, diagnostic issues, and management challenges

Prakash¹

2017

RRTM

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“…In brief, the patient, an employee in the mailroom of a New York City newspaper, presented with a rapidly growing nodule on his left forearm. Within 24 h, the nodule developed a central black eschar (6). Notably, histological sections from the biopsy specimen obtained after 3 days of antibiotic treatment showed an edematous lesion (with pronounced superficial papillary dermal edema with near-vesicle formation) with diffuse interstitial dermal collagen fibrin deposition, diffuse scattered acute inflammation, vascular congestion, and vasculitis.…”

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confidence: 99%

“…One sample (sample B) was from the patient described above, who presented clinically with a rapidly growing nodule over the flexor surface of his left forearm (6). The other two samples (samples A and C) were from patients who were suspected of having anthrax.…”

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confidence: 99%

PCR-Based Detection of Bacillus anthracis in Formalin-Fixed Tissue from a Patient Receiving Ciprofloxacin

Levine¹,

Pérez-Pérez²,

Olivares³

et al. 2002

J Clin Microbiol

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We demonstrate that Bacillus anthracis may be detected from a formalin-fixed, paraffin-embedded biopsy specimen, even after the patient has received antibiotic treatment. Although traditional PCR methods may not be sufficiently sensitive for anthrax detection in such patients, cycle numbers can be increased or PCR can be repeated by using an aliquot from a previous PCR as the template.Bacillus anthracis, the causative agent of anthrax, has been postulated to be a likely agent of biological warfare or terrorism because of its physical properties and its virulence factors (8). Nonetheless, anthrax had not been encountered in the United States as a weapon of terror until the fall of 2001 (2). Current reports have documented 22 cases of anthrax that have met the Centers for Disease Control and Prevention (CDC) case definition; 12 cases (7 confirmed and 5 suspected) were of the cutaneous form (3, 10). Due to variation in symptoms and findings in cases of cutaneous anthrax, a definitive diagnosis of infection requires identification of the organism within the tissue. However, many pathological specimens are routinely fixed in formalin and embedded in paraffin prior to histological examination. Such samples are easy to store, transport, and section for histological staining. Tissue architecture and proteins are well maintained with this method. Nonetheless, extraction of nucleic acids is difficult, often yielding only degraded DNA (4). Obtaining usable bacterial DNA is made more difficult if a patient has already been started on antibiotic therapy.We report our ability to amplify B. anthracis DNA from a formalin-fixed, paraffin-embedded skin biopsy specimen from a 34-year-old patient who had received ciprofloxacin for 3 days before the biopsy was performed. The major clinical features of this case have been previously reported (6; H. Yee, T. C. Gallagher, B. Strober, M. Pomerantz, M. Sanchez, S. Levine, M. J. Blaser, R. Hoffman, and B. A. Hanna, Abstr. 41st Intersci. Conf. Antimicrob. Agents Chemother., abstr. UL-7, 2001). In brief, the patient, an employee in the mailroom of a New York City newspaper, presented with a rapidly growing nodule on his left forearm. Within 24 h, the nodule developed a central black eschar (6). Notably, histological sections from the biopsy specimen obtained after 3 days of antibiotic treatment showed an edematous lesion (with pronounced superficial papillary dermal edema with near-vesicle formation) with diffuse interstitial dermal collagen fibrin deposition, diffuse scattered acute inflammation, vascular congestion, and vasculitis. A tissue Gram stain revealed scattered gram-positive, rod-shaped organisms, some of which were fragmented forms. Serological results for anthrax were negative, as were Gram-stained smears and cultures of the unfixed tissue. The CDC reported positive identification of anthrax in the tissue biopsy specimen by immunohistochemical staining.Formalin-fixed, paraffin-embedded tissue samples obtained by punch biopsies of skin from three different patients were studied....

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