title: Injectional anthrax at a Scottish district general hospital.
abstract: This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.
authors: Department of Microbiology,Monklands Hospital,Airdrie, Scotland,UK.
authors: D J
authors: DJ
authors: Inverarity
authors: Department of Anaesthetics and Intensive Care,Monklands Hospital,Airdrie, Scotland,UK.
authors: V M
authors: VM
authors: Forrester
authors: Department of General Surgery,Monklands Hospital,Airdrie, Scotland,UK.
authors: J G R
authors: JG
authors: Cumming
authors: Department of Haematology,Monklands Hospital,Airdrie, Scotland,UK.
authors: P J
authors: PJ
authors: Paterson
authors: Department of Pathology,Monklands Hospital,Airdrie, Scotland,UK.
authors: R J
authors: RJ
authors: Campbell
authors: Special Pathogens Reference Unit,Public Health England,Salisbury, England,UK.
authors: T J G
authors: TJ
authors: Brooks
authors: Special Pathogens Reference Unit,Public Health England,Salisbury, England,UK.
authors: G L
authors: GL
authors: Carson
authors: Department of Anaesthetics and Intensive Care,Monklands Hospital,Airdrie, Scotland,UK.
authors: J P
authors: JP
authors: Ruddy
mesh_terms: D000328:Adult; D000881:Anthrax / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: soft tissue infections