[Cutaneous anthrax: seven cases].

BACKGROUND

Anthrax is an acute infection caused by the Gram-positive organism, Bacillus anthracis, which rarely affects humans under normal conditions. Depending on the mode of contamination, there are three distinct clinical forms: pulmonary, gastrointestinal and cutaneous. This type of infection is still common in the developing countries, a fact that should be borne in mind by examining doctors, and in particular by dermatologists. It is important to recognise the clinical aspects of this disease rarely encountered in clinical practice since any delay in treatment may have fatal consequences, as illustrated by our case reports.

CASE REPORTS

Five men and two women of mean age 35years presented one or more cutaneous lesions of the upper limbs in all instances. All patients had a fever of 39-40 degrees C but none were presenting gastrointestinal or pulmonary signs. Neurological signs and/or disturbed consciousness were seen in three patients. Bacteriological diagnosis was based on isolation of B. anthracis in cultures of skin specimens. Treatment with parenteral or oral ciprofloxacin was initiated in six patients, and this therapy was combined with oral corticosteroids in three patients. A favourable outcome was achieved in four patients, while the remaining three patients died of their disease.

DISCUSSION

Anthrax is an anthropozoonosis that has now become rare in the developed countries. The disease is contracted by humans through touching either animals killed by anthrax or the products thereof. The cases we report were subsequent to collective contamination of several members of a single family, probably due to contact with goats carrying the disease. If left untreated, cutaneous anthrax may progress in 5 to 20% of cases to septicaemia with potentially lethal central nervous system involvement. The only means of eradicating anthrax in animals, and thus in humans, is through animal vaccination.