title: Evaluation of cutaneous palpebral anthrax.
abstract: BACKGROUND
  Anthrax is a rare disease caused by Bacillus anthracis. Antrax is zoonotic disease and is often encountered in persons engaged in animal husbandry. Cutaneous anthrax is approximately 95% of anthrax in humans. Palbebral involvement is rare.
  
  
  OBJECTIVE
  In this study, we aimed to evaluate the clinical presentation, diagnosis and treatment of cases with cutaneous palpebral anthrax.
  
  
  METHODS
  In this study, the patients diagnosed of cutaneous palpebral anthrax between January 2000 and December 2012, were investigated and evaluated, retrospectively. Cutaneous palpebral anthrax was diagnosed by the presence of typical anthrax lesion and/or observation of gram-positive encapsulated bacilli in gram prepations and/or culture positive of samples taken from lesions. In the cases who were culture-negative and without bacilli in gram-staining, the diagnosis was based on the presence of characteristic clinical presentation with a history of severe scarring formation, swelling, black eschar and positive response to the treatment.
  
  
  RESULTS
  A total of 21 patients with cutaneous palpebral anthrax admitted to the two hospitals between January 2000 and December 2012. Eight patients were male (38.1%) and 13 patients were female (61.9%), and the mean age was 31 ± 21.2 (range 1-82 years). The most common symptoms on admission to the hospital were swelling and redness on the skin. Periorbital lesions were in the right eye in 14 cases and the most common eyelid involvement was seen in upper eyelid with 15 cases. The diagnosis was based on isolation of bacteria in five (23.8%) cases, detection of gram-positive bacilli in direct examination of characteristic lesion material in six (28.5%) cases. Ten (47.7%) cases were diagnosed by the characteristic appearance of the lesion. Malignant pustule was seen in all of our patients and seven cases (33.4%) had malignant edema. In the treatment, penicilin was used for 10 (47.7%) cases, ampicillin-sulbactam for five (23.8%) cases and, ciprofloxacin for three (14.3%) cases. Cicatricial ectropion was observed in 10 (47.7%) patients, lagophthalmos developed in four (19%) patients, and corneal scar in two (9.5%) patients. The distribution of the cases did not differ by the year but showed a density in the months from July to September (62.7%).
  
  
  CONCLUSIONS
  Early diagnosis and high dose antibiotic treatment can facilitate the treatment and prevent development of eyelid complications including cicatricial ectropion, corneal scars and palpebral symphysis. Prolonged follow-up is necessary in patients who develop complications and surgical intervention.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, School of Medicine, Dicle University, Turkey. rectek21@hotmail.com
authors.forename: Recep
authors.initials: R
authors.lastname: Tekin
authors.forename: Seyhmus
authors.initials: S
authors.lastname: Ari
authors.forename: Tuba
authors.initials: T
authors.lastname: Dal
authors.forename: Safak
authors.initials: S
authors.lastname: Kaya
authors.forename: Mehmet Zeki
authors.initials: MZ
authors.lastname: Kortak
authors.forename: Birgül
authors.initials: B
authors.lastname: Dursun
authors.forename: Saim
authors.initials: S
authors.lastname: Dayan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000627:therapeutic use; D000881:Anthrax / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001408:Bacillus anthracis / Q000302:isolation & purification; D002437:Cefazolin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use; D005123:Eye / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D013407:Sulbactam / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002939:Ciprofloxacin; C035444:sultamicillin; D000667:Ampicillin; D002437:Cefazolin; D013407:Sulbactam