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Epidemiol Infect. 2015 Apr;143(6):1311-21. doi: 10.1017/S0950268814001885. Epub 2014 Jul 31.

Injectional anthrax at a Scottish district general hospital.

Author information

1
Department of Microbiology,Monklands Hospital,Airdrie, Scotland,UK.
2
Department of Anaesthetics and Intensive Care,Monklands Hospital,Airdrie, Scotland,UK.
3
Department of General Surgery,Monklands Hospital,Airdrie, Scotland,UK.
4
Department of Haematology,Monklands Hospital,Airdrie, Scotland,UK.
5
Department of Pathology,Monklands Hospital,Airdrie, Scotland,UK.
6
Special Pathogens Reference Unit,Public Health England,Salisbury, England,UK.

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.

KEYWORDS:

soft tissue infections

PMID:
25078285
DOI:
10.1017/S0950268814001885
[Indexed for MEDLINE]
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