title: First Autochthonous Coinfected Anthrax in an Immunocompetent Patient.
abstract: Cutaneous anthrax has a mortality rate of 20% if no antibacterial treatment is applied. The clinical manifestations of cutaneous anthrax are obviously striking, but coinfection may produce atypical lesions and mask the clinical manifestations and proper laboratory diagnosis. Anthrax is known to be more common in the Middle East and Iran is one of the countries in which the zoonotic form of anthrax may still be encountered. We report a case of a 19-years-old male who used to apply Venetian ceruse on his skin. Venetian ceruse (also known as Spirits of Saturn) is an old cosmetic product used for skin whitening traditionally made from sheep's spinal cord. The patient referred to the Referral Laboratory, Mazandaran University of Medical Sciences, Sari, Iran, with atypical dermatosis, pronounced pain, and oedema of the affected tissue. It was confirmed by both conventional and molecular analysis that culture was a mixture of Bacillus anthracis and Trichophyton interdigitale. The patient was initially treated with ceftriaxone (1000 mg/day for two weeks), gentamicin (1.5-2 mg/kg/day), terbinafine (200 mg/week for one month), and 1% clotrimazole cream (5 weeks) two times per day which resulted in gradual improvement. No relapse could be detected after one-year follow-up. Anthrax infection might present a broader spectrum of symptoms than expected by clinicians. These unfamiliar characteristics may lead to delayed diagnosis, inadequate treatment, and higher mortality rate. Clinicians need to be aware of this issue in order to have successful management over this infection.
authors.affiliation: Referral Laboratory, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Parvaneh
authors.initials: P
authors.lastname: Afshar
authors.affiliation: Invasive Fungi Research Center and Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Mohammad Taghi
authors.initials: MT
authors.lastname: Hedayati
authors.affiliation: Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Aslani
authors.affiliation: Department of Medical Mycology and Parasitology, Kurdistan University of Medical Sciences, Sanandaj, Iran ; Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sadegh
authors.initials: S
authors.lastname: Khodavaisy
authors.affiliation: Antimicrobial Resistance Research Center, Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Farhang
authors.initials: F
authors.lastname: Babamahmoodi
authors.affiliation: Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Mahdavi
authors.affiliation: CBS-KNAW Fungal Biodiversity Centre, Utrecht, Netherlands ; Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Dolatabadi
authors.affiliation: Pharmaceutical Sciences Research Center and Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Badali