Characteristics of cutaneous anthrax in Turkey.
BACKGROUND
Incidence of anthrax is diminishing in developed countries; however, it remains a public health problem in developing countries, especially those whose main source of income is farming.


METHODS
Charts of patients hospitalized between 1992 and 2008 in the Infectious Diseases and Clinical Microbiology Department of Ankara Numune Education and Research Hospital were reviewed.


RESULTS
Fifty-eight cases with cutaneous anthrax were reviewed. The mean age was 49.8, and 36.2% were female. The most common professions were farmers (62%), butchers (19%), and housewives (15%). The mean incubation period was eight days. Most cases (62%) were exposed to bacteria when butchering sick animals. Eighteen patients used an antibiotic before admission to hospital (31%). The predominantly affected sites were hands (39%) and fingers (29%), followed by forearms (12%), eyelids (7%) and necks (3%). All cases initially had painless ulcers with vesicles; dissemination of the lesion was seen in 27.5% of patients. Gram stain was positive in 11 cases; culture was positive in 7 cases for Bacillus anthracis. All patients except one were discharged and treated with penicillin and/or ciprofloxacin or imipenem. One patient with a disseminated lesion on the neck died even though a steroid was used with the antibiotic.


CONCLUSIONS
Cutaneous anthrax should be considered as a possible diagnosis in cases with a painless ulcer with vesicles, edema, and a history of exposure to animals or animal products. Despite previous antibiotic use, taking smears and cultures should be encouraged. Treatment with penicillin G or penicillin procain alone is effective for cases with cutaneous anthrax without severe edema and superinfection.
Infectious Diseases and Clinical Microbiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey. nbaykam@yahoo.com
Nurcan
N
Baykam
Onder
O
Ergonul
Aysegul
A
Ulu
Sebnem
S
Eren
Aysel
A
Celikbas
Mustafa
M
Eroglu
Basak
B
Dokuzoguz
D000881:Anthrax / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003906:Developing Countries; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D013194:Staining and Labeling; D014421:Turkey / Q000453:epidemiology
D000890:Anti-Infective Agents; D010406:Penicillins; D002939:Ciprofloxacin