Recent outbreak of cutaneous anthrax in Bangladesh: clinico-demographic profile and treatment outcome of cases attended at Rajshahi Medical College Hospital

Abstract

BackgroundHuman cutaneous anthrax results from skin exposure to B. anthracis, primarily due to occupational exposure. Bangladesh has experienced a number of outbreaks of cutaneous anthrax in recent years. The last episode occurred from April to August, 2011 and created mass havoc due to its dreadful clinical outcome and socio-cultural consequences. We report here the clinico-demographic profile and treatment outcome of 15 cutaneous anthrax cases attended at the Dermatology Outpatient Department of Rajshahi Medical College Hospital, Bangladesh between April and August, 2011 with an aim to create awareness for early case detection and management.FindingsAnthrax was suspected primarily based on cutaneous manifestations of typical non-tender ulcer with black eschar, with or without oedema, and a history of butchering, or dressing/washing of cattle/goat or their meat. Diagnosis was established by demonstration of large gram-positive rods, typically resembling B. anthracis under light microscope where possible and also by ascertaining therapeutic success. The mean age of cases was 21.4 years (ranging from 3 to 46 years), 7 (46.7%) being males and 8 (53.3%) females. The majority of cases were from lower middle socioeconomic status. Types of exposures included butchering (20%), contact with raw meat (46.7%), and live animals (33.3%). Malignant pustule was present in upper extremity, both extremities, face, and trunk at frequencies of 11 (73.3%), 2 (13.3%), 1 (6.7%) and 1 (6.7%) respectively. Eight (53.3%) patients presented with fever, 7 (46.7%) had localized oedema and 5 (33.3%) had regional lymphadenopathy. Anthrax was confirmed in 13 (86.7%) cases by demonstration of gram-positive rods. All cases were cured with 2 months oral ciprofloxacin combined with flucoxacillin for 2 weeks.ConclusionsWe present the findings from this series of cases to reinforce the criteria for clinical diagnosis and to urge prompt therapeutic measures to treat cutaneous anthrax successfully to eliminate the unnecessary panic of anthrax.

Source and risk factors of a cutaneous anthrax outbreak, Jiangsu, Eastern China, 2012

“…A cow with a latent anthrax infection can begin its journey healthy but become ill en route or soon after arriving after lengthy trucking. Previous studies have linked cutaneous B. anthracis outbreak with slaughtering of infected animals [15,16]. Apart from the fact that an outbreak of cattle anthrax cases had occurred in the area in August 2011 [13], we found genetic proof that this sick cow in Ganyu had been infected with B. anthracis.…”

Clinical Pathologic Conference Case 5: A Male Navy Diver With Oral and Skin Lesions

“…2 What favors this diagnosis is the fact that systemic toxic manifestations are uncommon among those who have been immunized, so the patient would not be expected to experience any physical illness or the acute-phase reacton common to bacterial infections. 3 The skin ulcerations exhibited by the current patient, although slightly inflamed, were flat and not likely necrotic. Finally, infection with Bacillus anthracis, the organism that causes anthrax, can manifest as both cutaneous and oropharyngeal ulcers.…”

Serodiagnosis of Human Cutaneous Anthrax in India Using an Indirect Anti-Lethal Factor IgG Enzyme-Linked Immunosorbent Assay

“…Recently, several cases of cutaneous anthrax were reported in Bangladesh (12,24,25). The incidence of anthrax outbreaks in the United States and Europe over the past 10 years (26,27) have emphasized the health threat that this infection poses.…”