Recent outbreak of cutaneous anthrax in Bangladesh: clinico-demographic profile and treatment outcome of cases attended at Rajshahi Medical College Hospital
BMC Research Notes
Recent outbreak of cutaneous anthrax in Bangladesh: clinico-demographic profile and treatment outcome of cases attended at Rajshahi Medical College Hospital
Muhammad Afsar Siddiqui 2
Md Azraf Hossain Khan 2
Sk Shamim Ahmed 0
Kazi Selim Anwar 1
Shaikh Md Akhtaruzzaman 2
Md Abdus Salam 0
0 Department of Microbiology, Rajshahi Medical College , Rajshahi 6000 , Bangladesh
1 Centre for injury Prevention and Research Bangladesh (CIPRB) , Dhaka , Bangladesh
2 Department of Dermatology, Rajshahi Medical College , Rajshahi 6000 , Bangladesh
Background: 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. Findings: 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. Conclusions: 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.
Cutaneous anthrax; Clinico-demographic profile; Therapeutic response; Bangladesh
Background
Anthrax is a zoonotic disease of antiquity caused by
Bacillus anthracis, an aerobic, spore-forming, large
gram-positive rod [
1
]. The incidence of anthrax infection
is diminishing in developed countries; however, it still
remains a public health problem in developing countries,
especially in areas where farming is the main source of
income. Soil is contaminated with anthrax spores from the
carcasses of dead animals and spores can survive for
decades, even under adverse conditions, to serve as a source
of infection for animals [
2
]. Humans are relatively
resistant to cutaneous invasion, but the organisms may gain
access through microscopic or gross breaks in the skin by
contact with infected animals or their products like meat,
hides, hair and bristles. There are three main forms of
human anthrax, depending on the route of exposure:
cutaneous, gastrointestinal and pulmonary or inhalational [
3
].
Cutaneous forms account for 95% of anthrax worldwide
[
4
] and is characterized by rapidly developing necrotizing
painless eschar (malignant pustule) with suppurative
regional adenitis. Cutaneous infection starts as one or more
painless, itchy papules or vesicles on the skin, typically on
exposed areas such as the face, neck, forearms or hands.
Within 7-10 days of the initial lesion, the papule forms an
ulcer. The ulcer subsequently crusts over, forming a
painless black eschar that is the hallmark of cutaneous
anthrax. In addition, localized swelling, painful swollen
regional lymph nodes and systemic symptoms can occur
[
5
]. There is no report of direct human-to-human
transmission in the literature and also there is no racial, sexual,
or age predilection for anthrax. However, because anthrax
is often related to industrial exposures and farming, the
disease most often affects young and middle-aged adults.
Death is rare with appropriate therapy, but untreated, the
case fatality rate may reach up to 20%.
Anthrax was described in the early literature of the
Greeks, Romans, Egyptians, and Hindus. The term
anthrakis means coal in Greek, and the disease is named
after the black appearance of its cutaneous form [
6
].
Until the twentieth century, anthrax infections killed
hundreds of thousands of animals and people each year
in Australia, Asia, Africa, Nor (...truncated)