title: Evaluation of 23 cutaneous anthrax patients in eastern Anatolia, Turkey: diagnosis and risk factors.
abstract: BACKGROUND
  Anthrax is a potentially fatal zoonotic disease. The diagnosis of cutaneous anthrax (CA) may be very difficult, particularly in atypical presentations and nonendemic regions.
  
  
  OBJECTIVE
  To evaluate the clinical features and diagnostic difficulties of 23 anthrax cases seen between May 2004 and September 2006.
  
  
  METHODS
  Twenty-three patients with CA were included in this study. The diagnosis of CA was based on clinical findings and/or microbiologic procedures.
  
  
  RESULTS
  All patients with a diagnosis of CA were followed up. One patient experienced toxemic shock. Twenty-two patients had a history of animal contact. Only one patient did not recall any history of suspicious contact. The clinical presentation of CA was typical in 20 patients (87%). Two patients were initially misdiagnosed with insect bites and one patient with angioedema. Cultures from the lesions were positive for Bacillus anthracis in seven cases (30.4%). Gram stain from the lesions revealed Gram-positive rods in eight cases (34.8%). Fifteen patients (65.2%) were diagnosed by clinical presentation and a history of contact with sick animals and/or contaminated animal products.
  
  
  CONCLUSIONS
  CA is a very contagious and important infectious disease worldwide. Early and accurate diagnosis dramatically affects the prognosis of the disease. The diagnosis of CA may be difficult, especially in atypical presentations and nonendemic areas. Thus, CA should be kept in mind, especially in these situations.
authors.affiliation: Department of Dermatology, Medical Faculty, Inonu University, Malatya, Turkey. hamdi.ozcan@inonu.edu.tr
authors.forename: Hamdi
authors.initials: H
authors.lastname: Ozcan
authors.forename: Uner
authors.initials: U
authors.lastname: Kayabas
authors.forename: Yasar
authors.initials: Y
authors.lastname: Bayindir
authors.forename: Mehmet R
authors.initials: MR
authors.lastname: Bayraktar
authors.forename: Selma
authors.initials: S
authors.lastname: Ay
mesh_terms: D000293:Adolescent; D000328:Adult; D000820:Animal Diseases / Q000382:microbiology*; D000818:Animals; D000881:Anthrax / Q000175:diagnosis* / Q000635:transmission*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D003951:Diagnostic Errors; D004487:Edema / Q000382:microbiology; D004890:Erythema / Q000382:microbiology; D005221:Fatigue / Q000382:microbiology; D005260:Female; D005334:Fever / Q000382:microbiology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000175:diagnosis*; D014421:Turkey; D055815:Young Adult; D015047:Zoonoses
chemical_list: D002097:C-Reactive Protein