Turhanoğlu Nezire Mine, Bayındır Bilman Fulya, Kutlu Yürüker Safiye
Diyarbakir Training and Research Hospital, Microbiology Clinic, Diyarbakir, Turkey.
Mikrobiyol Bul. 2013 Jul;47(3):538-43. doi: 10.5578/mb.5125.
Anthrax which is a rare disease in developed countries, is still a serious public health problem in countries like Turkey where livestock is common. In this report, four cases of cutaneous anthrax detected in Kirkira village of Diyarbakir, Southeast Anatolia, Turkey, were presented. Three female and one male patients were admitted to our hospital with the complaints of skin lesions and high fever lasting for 10 days. Their history indicated that they injured their fingers during slaughtering of a dead cow meat. All patients had irregular edged necrotic vesiculobullous lesions on the erythematous and edematous base on their hand fingers, developed in 1 week following the contact. There was no systemic finding and the laboratory findings were within normal limits. Typical bamboo cane shaped gram-positive bacilli were observed on the Gram stained smears prepared from the vesicular lesions. Aerobic cultures in blood agar media revealed typical R type colonies, gray in color, creased, granulated and 2-3 mm in diameter within 24 hours of incubation. In one patient although the lesion was typical and characteristic gram-positive bacilli were detected in the Gram stained smears, no growth was seen in the cultures. The isolates (n= 3) were identified as Bacillus anthracis by conventional microbiological methods, and also confirmed by Vitek 2 (BioMerieux, France) automated identification system. Antibiotic susceptibility tests were performed by disc diffusion method according to the CLSI guidelines. The isolates were found susceptible to penicillin G, ampicillin, erythromycin, amikacin, chloramphenicol, tetracycline, vancomycin and ciprofloxacin. All of the patients were treated successfully with penicillin or ciprofloxacin accompanied by topical wound care. In the last years several case series of anthrax were reported especially from the East and Southeastern Anatolia regions of Turkey. These four cutaneous anthrax cases from Diyarbakir, Turkey were reported to withdraw attention to anthrax in that specific area. It was concluded that in areas where anthrax is endemic to educate people under risk, to take the necessary preventive measures and to rule out anthrax in the differential diagnosis of cases presenting with typical ulcers and had contact with animals or their products, are of crucial importance for the early initiation of appropriate treatment which would decrease related morbidity and mortality.
炭疽病在发达国家是一种罕见疾病，但在土耳其等畜牧业发达的国家，仍然是一个严重的公共卫生问题。在本报告中，介绍了在土耳其安纳托利亚东南部迪亚巴克尔省基尔基拉村发现的4例皮肤炭疽病例。3名女性和1名男性患者因皮肤损伤和持续10天的高烧症状入院。他们的病史显示，他们在屠宰一头死牛肉时手指受伤。所有患者手指上均出现边缘不规则的坏死性水疱大疱性病变，病变部位皮肤红肿，这些病变在接触后1周内出现。患者无全身症状，实验室检查结果均在正常范围内。从水疱性病变制备的革兰氏染色涂片中观察到典型的竹节状革兰氏阳性杆菌。在血琼脂培养基上进行需氧培养，培养24小时后可见典型的R型菌落，菌落呈灰色，有皱纹，颗粒状，直径2-3毫米。其中1例患者虽然病变典型，革兰氏染色涂片中检测到典型的革兰氏阳性杆菌，但培养未见细菌生长。通过传统微生物学方法将分离出的3株细菌鉴定为炭疽芽孢杆菌，并通过Vitek 2（法国生物梅里埃公司）自动鉴定系统进行了确认。根据CLSI指南，采用纸片扩散法进行药敏试验。分离出的细菌对青霉素G、氨苄西林、红霉素、阿米卡星、氯霉素、四环素、万古霉素和环丙沙星敏感。所有患者均接受了青霉素或环丙沙星治疗，并辅以局部伤口护理，治疗均获成功。在过去几年里，土耳其尤其是东部和东南部安纳托利亚地区报告了几例炭疽病例系列。报告这4例来自土耳其迪亚巴克尔的皮肤炭疽病例，旨在引起对该特定地区炭疽病的关注。得出的结论是，在炭疽病流行地区，对有风险的人群进行教育、采取必要的预防措施以及在对出现典型溃疡且接触过动物或其产品的病例进行鉴别诊断时排除炭疽病，对于早期开始适当治疗至关重要，这将降低相关的发病率和死亡率。
