title: A case report of inhalation anthrax acquired naturally.
abstract: BACKGROUND
  Anthrax is a zoonotic occupational disease caused by Bacillus anthracis, a rod-shaped immobile aerobic gram-positive bacteria with spore. Anthrax occurs in humans randomly and with low frequency. Most cases of anthrax are acquired through contact with infected animals or contaminated animal products. This old disease became particularly important since 2001 that the biological spores were exploited in America. Depending on the transmission method of the disease, clinical manifestations occur in three classes: Cutaneous, respiratory, and gastrointestinal anthrax. The respiratory form is considered as the most fatal and a rare form of anthrax intending to show complicated and unusual manifestations.
  
  
  METHODS
  In this case report a rare case of inhalation anthrax acquired naturally in southeast of Iran is presented. A blind 65-year-old man, living in a rural area, was admitted with respiratory infection, fever, dyspnea, loss of appetite, and myalgia. The patient was treated with outpatient antibiotics a week ago. After admission, the patient was again treated for pneumonia, but there was no improvement despite treatment and the patient was suffering from septicemia symptoms. Radiographic images showed wide mediastinum. Bacillus anthracis was isolated from blood and sputum culture and the results were confirmed by colony morphology, biochemical reactions and PCR. The treatment was changed to ciprofloxacin, clindamycin, and penicillin. On the second day of anthrax treatment, the patient was complicated with jaundice, elevation of liver enzymes, and a significant drop in hemoglobin, hematocrit, and platelet despite lack of obvious bleeding and was complicated with respiratory distress and sepsis and died a week after treatment.
  
  
  CONCLUSIONS
  We could discover no specific exposure associated with anthrax infection for this patient. However, due to being located in an endemic and enzootic area, it is proposed that the exposure occurred through contact with infected airborne dust or an unknown contaminated item. Despite many advances in preventing anthrax, still some rare cases of respiratory and complicated anthrax are emerging. With regard to the threat of bioterrorism, medical staff's sensitivity to the clinical syndrome, methods of prophylaxis and treatment of anthrax must be raised. Fast diagnosis and successful treatment the lethal cases of this infection are of utmost important.
authors.affiliation: Medical Faculty, Hepatitis Research Center, Birjand University of Medical Sciences, Brijand, Iran. drz.azarkar@yahoo.com.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Azarkar
authors.affiliation: Hepatitis Research Center, Medical Microbiology Department, Paramedical Faculty, Birjand University of Medical Sciences, Ghafari Avenue, Birjand, South Khorasan, Iran. m.zare@live.co.uk.
authors.forename: Majid Zare
authors.initials: MZ
authors.lastname: Bidaki
mesh_terms: D000368:Aged; D000818:Animals; D000881:Anthrax / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001408:Bacillus anthracis / Q000254:growth & development / Q000302:isolation & purification / Q000472:pathogenicity*; D002939:Ciprofloxacin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D007565:Jaundice / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D008297:Male; D010406:Penicillins / Q000627:therapeutic use; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D018805:Sepsis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D017211:Treatment Failure; D015047:Zoonoses / Q000635:transmission
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002981:Clindamycin; D002939:Ciprofloxacin