Siddiqui Muhammad Afsar, Khan Md Azraf Hossain, Ahmed Sk Shamim, Anwar Kazi Selim, Akhtaruzzaman Shaikh Md, Salam Md Abdus
BMC Res Notes. 2012 Aug 28;5:464. doi: 10.1186/1756-0500-5-464.
Human 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.
Anthrax 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.
We 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.
人类皮肤炭疽是皮肤接触炭疽杆菌所致，主要源于职业暴露。近年来，孟加拉国经历了多次皮肤炭疽疫情爆发。最近一次疫情发生在2011年4月至8月，因其可怕的临床后果和社会文化影响造成了大规模破坏。我们在此报告2011年4月至8月期间在孟加拉国拉杰沙希医学院医院皮肤科门诊就诊的15例皮肤炭疽病例的临床人口统计学特征及治疗结果，旨在提高对早期病例检测和管理的认识。
主要根据典型的无痛性溃疡伴黑色焦痂的皮肤表现，有无水肿，以及屠宰、处理/清洗牛/羊或其肉的病史怀疑为炭疽。通过在光学显微镜下尽可能显示典型类似炭疽杆菌的大革兰氏阳性杆菌，并确定治疗成功来确诊。病例的平均年龄为21.4岁（3至46岁），男性7例（46.7%），女性8例（53.3%）。大多数病例来自社会经济地位较低的中等阶层。暴露类型包括屠宰（20%）、接触生肉（46.7%）和活体动物（33.3%）。恶性脓疱出现在上肢、双上肢、面部和躯干的频率分别为11例（73.3%）、2例（13.3%）、1例（6.7%）和1例（6.7%）。8例（53.3%）患者出现发热，7例（46.7%）有局部水肿，5例（33.3%）有区域淋巴结病。13例（86.7%）病例通过显示革兰氏阳性杆菌确诊为炭疽。所有病例均采用口服环丙沙星2个月联合氟氯西林治疗2周治愈。
我们展示这一系列病例的研究结果，以强化临床诊断标准，并敦促采取及时的治疗措施成功治疗皮肤炭疽，消除对炭疽不必要的恐慌。
