Isezuo Khadijat Omeneke, Sani Usman Muhammad, Waziri Usman Muhammad, Zaiyanu Sa'ima Abdullahi, Folorunsho Abdulrasheed, Shehu Sirajo, Akpelu Hechime Enyida, Amodu-Sanni Maryam, Aliyu Nuhu Dogondaji, Mohammed Yahaya
Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Epidemiologist Unit, Ministry of Health, Sokoto State, Nigeria.
Niger Med J. 2025 Jan 10;65(6):1176-1184. doi: 10.60787/nmj.v65i6.597. eCollection 2024 Nov-Dec.
Anthrax is a life-threatening zoonotic disease caused by Gram-positive, spore-forming bacterium . It manifests as a cutaneous, gastrointestinal, and respiratory disease. The cutaneous form ranges from a self-limiting lesion to severe edematous lesions with toxemic shock. Of recent, increasing cases of anthrax have been reported in Nigeria warranting heightened surveillance. A patient with skin lesions suggestive of cutaneous anthrax and toxic manifestations is reviewed to emphasize the need for a high index of suspicion.
A 14-year-old boy presented with skin lesions of one month involving the hands, face, and legs, left lower limb swelling of two weeks, fever of 10 days, and fast breathing of five days duration. There was a positive history of contact with cattle carcasses at the abattoir. He was febrile (38.1c), mildly pale, and mildly dehydrated, oxygen saturation was 95%. He was tachypnoeic and tachycardic with a low-volume pulse. There was extensive left lower limb swelling, a raised necrotic ulcer with a black surface on the calf, measuring 9cmx5cm with serosanguinous discharge, and another confluent vesicular lesion on the anterolateral aspect of the left leg measuring 8cmx6cm. Differential diagnoses considered were cellulitis, osteomyelitis, leishmaniasis, and malignancy.
RESULT TREATMENT & OUTCOME: His packed cell volume was 33%, retroviral screening, and hepatitis screening were nonreactive, and erythrocyte sedimentation rate was 3mm/hr. Leg X-ray was normal. Other investigations could not be done due to financial constraints and the patient's demise. He received intravenous (IV) fluid, IV ceftriaxone, IV metronidazole, tetanus toxoid, and antiseptic wound dressing. He succumbed to the illness 72 hours later. Anthrax was considered after the patient's demise due to the type of skin lesion and progression of the illness in line with the standard case definition.
Cutaneous anthrax with systemic manifestations should be considered as a probable diagnosis in patients with typical skin lesions and toxic features.
炭疽是一种由革兰氏阳性、形成芽孢的细菌引起的危及生命的人畜共患病。它表现为皮肤、胃肠道和呼吸道疾病。皮肤型炭疽从自限性病变到伴有中毒性休克的严重水肿性病变不等。最近，尼日利亚报告的炭疽病例有所增加，需要加强监测。本文对一名有皮肤病变提示皮肤炭疽及中毒表现的患者进行回顾，以强调高度怀疑的必要性。
一名14岁男孩出现皮肤病变1个月，累及手部、面部和腿部，左下肢肿胀2周，发热10天，呼吸急促5天。有在屠宰场接触牛尸体的阳性病史。他发热（38.1℃），轻度苍白，轻度脱水，血氧饱和度为95%。他呼吸急促、心动过速，脉搏细弱。左下肢广泛肿胀，小腿有一个凸起的坏死溃疡，表面黑色，大小为9cm×5cm，有血清样渗出物，左腿前外侧还有一个融合性水疱病变，大小为8cm×6cm。考虑的鉴别诊断包括蜂窝织炎、骨髓炎、利什曼病和恶性肿瘤。
结果 治疗与转归：他的红细胞压积为33%，逆转录病毒筛查和肝炎筛查均无反应，红细胞沉降率为3mm/小时。腿部X线检查正常。由于经济限制和患者死亡，无法进行其他检查。他接受了静脉输液、静脉注射头孢曲松、静脉注射甲硝唑、破伤风类毒素和伤口消毒敷料。72小时后他因病死亡。由于皮肤病变类型和病情进展符合标准病例定义，患者死亡后考虑为炭疽。
对于有典型皮肤病变和中毒特征的患者，应将伴有全身表现的皮肤炭疽视为可能的诊断。
