Factors leading to dissemination of cutaneous anthrax: an international ID-IRI study
Elbahr U.S. Tekin R. Papić M. Pandak N. Erdem H. Can F.K. Alpat S.N. Pekok A.U. Pehlivanoglu F. Karamese M. Petru P.C. Kulzhanova S. Tosun S. Doğan M. Moroti R. Ramosaco E. Alay H. Puca E. Arapovic J. Pshenichnaya N. Fasciana T. Giammanco A.
July 2022Elsevier Ltd
New Microbes and New Infections
2022#48
Background: Although anthrax is a rare zoonotic infection, it still causes significant mortality and morbidity. In this multicenter study, which is the largest anthrax case series ever reported, we aimed to describe the factors leading to dissemination of cutaneous anthrax. Methods: Adult patients with cutaneous anthrax from 16 referral centers were pooled. The study had a retrospective design, and included patients treated between January 1, 1990 and December 1, 2019. Probable, and confirmed cases based upon CDC anthrax 2018 case definition were included in the study. A descriptive statistical analysis was performed for all variables. Results: A total of 141 cutaneous anthrax patients were included. Of these, 105 (74%) patients had probable and 36 (26%) had confirmed diagnosis. Anthrax meningitis and bacteremia occurred in three and six patients, respectively. Sequelae were observed in three patients: cicatricial ectropion followed by ocular anthrax (n = 2) and movement restriction on the left hand after surgical intervention (n = 1). One patient had gastrointestinal anthrax. The parameters related to poor outcome (p < 0.05) were fever, anorexia, hypoxia, malaise/fatigue, cellulitis, fasciitis, lymphadenopathy, leukocytosis, high CRP and creatinine levels, longer duration of antimicrobial therapy, and combined therapy. The last two were seemingly the consequences of dissemination rather than being the reasons. The fatality rate was 1.4%. Conclusions: Rapid identification of anthrax is crucial for prompt and effective treatment. Systemic symptoms, disseminated local infection, and high inflammatory markers should alert the treating physicians for the dissemination of the disease.
Anthrax , Bacteremia , Gastrointestinal , Meningitis , Mortality , Outcome
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Bahrain Oncology Center, King Hamad University Hospital, Department of Infectious Diseases, AlMuharraq, Bahrain
Department of Infectious Diseases, School of Medicine, Dicle University, Diyarbakir, Turkey
Libertas International University, Zagreb, Croatia
The Royal Hospital, Muscat, Oman
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Department of Infectious Diseases, VM Medical Park, Pendik Hospital, Istanbul, Turkey
Department of Clinical Microbiology and Infectious Diseases, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
Department of Medical Microbiology, Kafkas University, Kars, Turkey
Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
Department of Infectious Diseases, Namık Kemal University School of Medicine, Tekirdag, Turkey
National Institute for Infectious Diseases ‘Matei Bals, and ‘Carol Davila’ University of Medicine and Pharmacy’, Bucharest, Romania
Infectious Diseases Clinic, University Hospital Center “Mother Teresa”, Tirana, Albania
Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
Central Research Institute of Epidemiology, Moscow, Russian Federation
Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence G. DAlessandro, University of Palermo, Palermo, 90127, Italy
Bahrain Oncology Center
Department of Infectious Diseases
Libertas International University
The Royal Hospital
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Disease and Clinical Microbiology
Department of Infectious Diseases
Department of Clinical Microbiology and Infectious Diseases
Department of Medical Microbiology
Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases
Department of Infectious Diseases
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases
National Institute for Infectious Diseases ‘Matei Bals
Infectious Diseases Clinic
Department of Infectious Diseases
Central Research Institute of Epidemiology
Department of Health Promotion
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