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The clinical features of ten cases of cutaneous anthrax are reported. Six males and four females were affected. Their ages ranged from one and a half year to sixty years. The average incubation period was 8 days. Fever and headache were common systemic manifestations. Pruritus and ulcer with formation of black eschar were typical features. The patients were treated with penicillins and chloramphenicol. There was no mortality. Possible human-to-human spread in a patient is discussed.
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PMID:Cutaneous anthrax--a report of ten cases. 163 66

Thirty human anthrax cases were reported from Ramabhadrapuram village of Chittoor district in Andhra Pradesh during November-December, 1989. These cases occurred following an epizootic of anthrax among cattle and sheep of the village and ingestion of contaminated meat by the villagers. The overall attack rate was 24.39 per cent with a case fatality of 16.67 per cent. All age groups and both sexes were affected. Ten cases were of cutaneous form with typical black eschar formation which were confirmed bacteriologically. Fever and headache were common systemic manifestations. They responded well to penicillins and there was no mortality. The possibility of human to human spread is suggested. The twenty cases of internal anthrax comprised intestinal, septicemic, peritonitis, meningeal and pulmonary forms. Sub-clinical forms also occurred. Fever, abdominal pain, ascites, anorexia and vomiting were notable features. Diagnosis was made clinically and also on epidemiological basis. All deaths during this outbreak occurred in women with internal anthrax, the case fatality rate for the latter being 25 per cent. Prophylactic administration of penicillin was done for individuals at risk.
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PMID:Outbreak of human anthrax in Ramabhadrapuram village of Chittoor district in Andhra Pradesh. 209 91

We report the first case of fatal anthrax meningoencephalitis in Hong Kong over the past 60 years. A 13 year-old boy presented with right lower quadrant pain, diarrhoea and progressive headache. Lumbar puncture yielded gram positive bacilli initially thought to be Bacillus cereus, a contaminant. He was treated with ampicillin and cefotaxime, but died 3 days after hospitalization. The organism isolated from blood and cerebrospinal fluid was later identified as Bacillus anthracis.
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PMID:Fatal meningoencephalitis due to Bacillus anthracis. 948 89

There are three clinical presentations of anthrax in humans: cutaneous (>95% of cases), orogastric and inhalational. The infectious form, the spore, enters the body and is thought to germinate within macrophages either at the site of inoculation (cutaneous or orogastric) or in the regional lymph node (inhalational). The bacillus then synthesizes its antiphagocytic capsule and the lethal and oedema toxins which interfere with the non-specific host defences leading to the characteristic locally destructive lesion and spread by lymphatics to the systemic circulation and other organs. The cutaneous form begins as a papule which progresses over several days to a vesicle and then ulcerates. There is often oedema, sometimes massive, probably due to the oedema toxin that surrounds the lesions which then develop a characteristic black eschar. The patient may be febrile with mild to severe systemic symptoms of malaise, headache and toxicity. Oropharyngeal anthrax presents with severe sore throat or an ulcer in the oropharyngeal cavity associated with neck swelling, fever, toxicity and dysphagia. Gastrointestinal anthrax begins with anorexia, nausea, vomiting and abdominal pain which may be similar to an acute abdomen. There may be diarrhoea and ascites, both of which may be haemorrhagic. Inhalational anthrax begins with non-specific symptoms of malaise, fever, myalgia and non-productive cough. After a period of 2-3 days, this is followed by a sudden onset of severe respiratory distress associated with diaphoresis, cyanosis and increased chest pain. There may be a widened mediastinum and pleural effusions on chest X-ray. Death follows in 24-36 h from respiratory failure, sepsis and shock. The diagnosis of anthrax is easy if it is considered. The organism is readily observed by Gram or Wright stain in local lesions or blood smear and can be easily cultured from the blood and other body fluids. However, because of its rarity, it is not often included in the differential diagnosis and in inhalational disease the diagnosis is rarely made until the patient is moribund. More rapid diagnostic tests are under development. Penicillin, combined with supportive care, remains the mainstay of treatment, although the organism is susceptible in vitro to many antibiotics. In recent years, there have been significant advances in our knowledge of the organism and its toxins and it is anticipated that similar progress will be made in the future in developing more rapid diagnostic tests and new modalities of treatment.
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PMID:Clinical aspects, diagnosis and treatment of anthrax 1047 74

Anthrax bacterium, once the deadly scourge of goat-hair workers, has become the bane of the U.S. defense establishment. Without infecting a single soldier, it has created a logistical headache for the Pentagon, as military contractors have fallen far short of supplying a vaccine that will protect all troops and be acceptable to health authorities. Last week military officials were forced to beat a hasty retreat in their current efforts, raising the hackles of legislators who already had serious doubts about the program.
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PMID:Bioterrorism. DOD retreats on plan for anthrax vaccine. 1093 44

The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.
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PMID:Clinical presentation of inhalational anthrax following bioterrorism exposure: report of 2 surviving patients. 1172 75

After inhalational anthrax was diagnosed in a Connecticut woman on November 20, 2001, postexposure prophylaxis was recommended for postal workers at the regional mail facility serving the patient's area. Although environmental testing at the facility yielded negative results, subsequent testing confirmed the presence of Bacillus anthracis. We distributed questionnaires to 100 randomly selected postal workers within 20 days of initial prophylaxis. Ninety-four workers obtained antibiotics, 68 of whom started postexposure prophylaxis, and of these, 21 discontinued. Postal workers who never started or stopped taking prophylaxis cited as reasons disbelief regarding anthrax exposure, problems with adverse events, and initial reports of negative cultures. Postal workers with adverse events reported predominant symptoms of gastrointestinal distress and headache. The influence of these concerns on adherence suggests that communication about risks of acquiring anthrax, education about adverse events, and careful management of adverse events are essential elements in increasing adherence.
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PMID:Anthrax postexposure prophylaxis in postal workers, Connecticut, 2001. 1239 28

The Centers for Disease Control and Prevention urge physicians to become familiar with chemical and biological weapons. Preparedness among neurologists is especially important because several of these agents affect the nervous system. This article reviews 4 agents that have a history of military or terrorist use: cyanide poisons, organophosphate poisons, botulinum toxin, and anthrax. Cyanide and organophosphate poisons are characterized by dose-dependent impairment of neurological function with nonspecific symptoms such as headache or dizziness at one end of the spectrum and convulsions and coma at the other. Neurological examinations help clinicians to differentiate these agents from other intoxications. Botulinum toxin has a delayed onset of action and results in descending paralysis and prominent cranial nerve palsies. Anthrax frequently causes fulminating hemorrhagic meningitis. Early recognition of these chemical and biological weapons is key to instituting specific therapy and preventing casualties within the health care team and the community at large.
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PMID:Neurological aspects of biological and chemical terrorism: a review for neurologists. 1253 84

Biological warfare is a potential threat on the battlefield and in daily life. It is vital for neurologists and other health care practitioners to be familiar with biological and toxic agents that target the nervous system. most illnesses caused by biological warfare agents are not commonly considered neurologic disease, however. Many of these agents (such as anthrax) may present with headache, meningitis, or mental status changes in addition to fever and other symptoms and signs (Tables 2 and 3). Thus, a neurologist may be consulted acutely to aid in diagnosis. Because of the incubation time of many biological agents and their protean manifestations, it is likely that health care workers will be on the front lines in the event of a bioterrorist attack. We must be prepared.
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PMID:Neurobiological weapons. 1575 99

The incidence of anthrax is decreasing in Turkey, however, it is still endemic in some regions of the country. Although central nervous system involvement is rare in cases with anthrax, high mortality rates are significant. Here, we report a 46-years old woman who was anthrax meningoencephalitis. The patient was from Yozgat located in Central Anatolia, Turkey. Her history revealed that following peeling the skin of sheeps and consuming their meat a week ago, a lesion developed in her left forearm and she had been treated with penicilin G with the diagnosis of cutaneous anthrax in a local health center. The patient was admitted to the emergency room of our hospital due to increased headache and loss of conciousness and diagnosed as anthrax meningitis. Crytallized penicilin G (24 MU/day IV) and vancomycin (2 g/day IV) were initiated. The macroscopy of cerebrospinal fluid (CSF) sample was haemorrhagic, white blood cell count was 40/mm3 (80% of neutrophil) and Gram staining of CSF yielded abundant gram-positive bacilli. The diagnosis was confirmed by the isolation of Bacillus anthracis from CSF culture. Although the isolate was susceptible to penicillin and dexamethasone was added to the treatment, the patient died. Review of the Turkish literature revealed seven cases of anthrax with central nervous system involvement between 1980-2008. One of the patients was an 11-years old boy and the others were adults aged between 19 and 64 years. The source of the infection was skin in four patients and inhalation in one patient. The most common findings in all of the patients were inhabitance in rural area, haemorrhagic CSF and loss of all patients despite appropriate antibiotic therapy. In conclusion, anthrax meningitis and meningoencephalitis should be considered in the differential diagnosis of haemorrhagic meningitis in areas where anthrax is endemic and high rate of mortality despite appropriate therapy should always be kept in mind.
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PMID:[Anthrax meningoencephalitis: a case report and review of Turkish literature]. 2008 23


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