Injectional anthrax - new presentation of an old disease

Abstract

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Anthrax in injecting drug users: the need for increased vigilance in the clinic

“…Notably, while marked edema was observed in a number of patients, the characteristic cutaneous anthrax eschars were reported to be absent in almost all cases published so far [2,10,11]. Necrosis and blistering of the tissues in some cases led to the misdiagnosis of compartment syndrome or necrotizing fasciitis; however, unlike these conditions, erythema, and fever and pain are not pronounced features of IA, and white cell count, C-reactive protein and lactate are not significantly elevated [10,11]. Equally, clinicians should be aware of the possibility for cellulitis and necrotizing fasciitis to develop in IA cases [9,12].…”

“…The first outbreak, which centered on persons who inject drugs in Scotland, with cases in England and Germany, was originally diagnosed in two heroin users from the Greater Glasgow and Clyde area, presenting with blood cultures positive for B. anthracis [9]. Eventually, 54 laboratory-confirmed cases, with a 33% fatality rate, were reported for the initial outbreak [10]. The second, smaller, wave of cases was more widely distributed geographically, with 15 laboratory-confirmed cases diagnosed in England, Scotland, Wales, Germany, Denmark and France; a case fatality rate of 47% was reported for this cluster [10].…”

“…Eventually, 54 laboratory-confirmed cases, with a 33% fatality rate, were reported for the initial outbreak [10]. The second, smaller, wave of cases was more widely distributed geographically, with 15 laboratory-confirmed cases diagnosed in England, Scotland, Wales, Germany, Denmark and France; a case fatality rate of 47% was reported for this cluster [10]. The etiology of IA differs from the classical routes of infection in several ways.…”

“…In general, management consisted of intravenous administration of conventional antimicrobial agents and supportive therapy [10,15]. It is important to note that B. anthracis isolates have been identified which display resistance to frontline antibiotics used in the treatment of anthrax, particularly b-lactams [16]; therefore, combination therapy is recommended in preference to monotherapy.…”

An Aggregate of Four Anthrax Cases during the Dry Summer of 2011 in Epirus, Greece

“…Most human cases result from environmental (occupational) exposure [7,8]; however, several cases of severe anthrax infections among injecting drug users in Western Europe have been reported since 2009 (probably as a result of the use of contaminated heroin) [8,9]. An important epidemiological characteristic of anthrax is the distinct seasonality of the cases, a feature that has been linked to the annual variations of local weather factors.…”