title: Cutaneous anthrax: evaluation of 28 cases in the Eastern Anatolian region of Turkey.
abstract: BACKGROUND
  Anthrax is an endemic disease in developing countries. Human cases are usually associated with animal products. About 95% of naturally acquired cases are cutaneous anthrax.
  
  
  OBJECTIVE
  In this study, cutaneous anthrax cases from the Elazig province (the Eastern Anatolian region) of Turkey seen in our hospital within a 6-year period were evaluated with respect to epidemiological and clinical features, diagnosis, treatment and outcome.
  
  
  METHODS
  Twenty-eight patients with cutaneous anthrax observed between January 2009 and December 2014 were investigated retrospectively. The diagnosis of cutaneous anthrax was based on detailed history, dermatologic findings, including painless, ulcers covered by a characteristic black eschar and/or microbiological procedures, including Gram stain and culture of materials obtained from the lesions.
  
  
  RESULTS
  Of the 28 patients followed up with cutaneous anthrax diagnosis, 14 (50%) were female and 14 (50%) were male. The mean age of the cases was 39.6 years (age range 17-65 years). The patients have an incubation period in the range of 1-9 days (mean 4.6 ± 0.5 days). The cases were seen between April and November of each year during the study period. Twenty-three cases (82%) had a history of contact with animals or animal products. Twenty patients (71.4%) showed malignant pustules and eight (28.6%) malignant edema. Bacillus anthracis was isolated in three cases (10.7%) and Gram stain smear were positive in five cases (17.8%). All patients were treated successfully with penicillin or ciprofloxacin. Systemic corticosteroids were added to the antibiotic treatment in six patients with malignant edema. Sepsis no developed in patients, all the cases recovered.
  
  
  CONCLUSIONS
  Anthrax is still a serious public health problem in Turkey. Cutaneous anthrax must always be kept in mind when characteristic lesions such as a painless ulcer with vesicles, edema, and a history of contact with animals or animal products are observed in an individual. Early and correct diagnosis significantly affects course of the disease. Protective precautions such as vaccination of animals against anthrax and education of the population would reduce the incidence of the disease.
authors: a Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine , Firat University , Elazig , Turkey .
authors: Affan
authors: A
authors: Denk
authors: b Department of Infectious Diseases and Clinical Microbiology , Cizre State Hospital , Sirnak , Turkey , and.
authors: Ayse Sagmak
authors: AS
authors: Tartar
authors: a Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine , Firat University , Elazig , Turkey .
authors: Mehmet
authors: M
authors: Ozden
authors: c Department of Dermatology, Faculty of Medicine , Firat University , Elazig , Turkey.
authors: Betul
authors: B
authors: Demir
authors: a Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine , Firat University , Elazig , Turkey .
authors: Ayhan
authors: A
authors: Akbulut
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000881:Anthrax / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001408:Bacillus anthracis / Q000302:isolation & purification; D002939:Ciprofloxacin / Q000627:therapeutic use; D004487:Edema / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D010406:Penicillins; D002939:Ciprofloxacin
keywords: Cutaneous anthrax; endemic disease; outcome; zoonosis