Case Report
BibTex RIS Cite

A rare presentation of anthrax with sepsis: A case report

Year 2018, Volume:3 Issue: 3, 210 - 213, 30.11.2018
https://doi.org/10.25000/acem.457035

Abstract

Anthrax is a zoonotic infection caused by Bacillus anthracis. Although the incidence of the disease is decreasing in our country, it is still endemic in certain regions of the country. The cutaneous form of the disease is the most common clinical form, which is usually benign and rarely causes bacteriemia and sepsis. In this case report, a cutaneous anthrax case who had positive blood and wound cultures  and  were complicated  with sepsis are presented. 

A 39-years-old male patient living in Kars (Eastern Turkey) was admitted with systemic fever, chills,and a wound with swelling redness  on the right arm. In his medical history, the patient stated an insect (fly) bite three days ago and consequent development of a lesion on his right arm. He also stated that he had slaughtered a lamb 10 days ago by himself. On admission, the patient was detected to have a 2-3 cm centrally necrotic and peripherally edematous wound confined to the right forehand. There was also fever, hyperemia and general edema confined to right arm up to the shoulder level. With the preliminary diagnosis of cutaneous anthrax, the patient was hospitalized, and ampicillin-sulbactam therapy was started, but due to the progression of the lesion and clinical deterioration, the treatment was changed to piperacillin-tazobactam and clindamycin. The swab samples from the wound were sent to the laboratory and revealed Gram-positive sporulated bacilli and following blood cultures were also positive for growth. The agent pathogen was identified as B.anthracis by Gram stains from wound samples and blood cultures which was susceptible to penicillin. MLVA method with 25 loci was used for genotyping, and it was determined that the genotype in our case is GK43 that is located in the major cluster A and subset 3. On the tenth day of hospitalization due to the widespread and necrotic lesions on his arm , compartment syndrome had been occurred. Escharatomy had been established for the treatment of comparment syndrome. After three weeks of antibiotherapy, the patient has been discharged from the hospital with good health.

As a conclusion, this case report reminds need of
high attention to the clinical course of
cutaneous anthrax in order to avoid severe complications such as sepsis.

References

  • 1. Doganay M. Anthrax. In: Cohen J, Powderly WG, Opal S (eds), Infectious Diseases. 2010, 3rd ed. Mosby-Elsevier, 2010:1257-61.
  • 2. Lucey D. Bacillus anhtracis (Anthrax). In: Mandell GL, Bennett JE, Dolin R (eds), Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 6th ed. Churchill Livingstone, 2005:2485-93.
  • 3. Ertek M. Şarbonun ülkemizdeki durumu. ANKEM Derg. 2011;25:88-91.
  • 4. Durmaz R, Doganay M, Sahin M, Percin D, Karahocagil MK, Kayabas U, et al. Molecular epidemiology of the Bacillus anthracis isolates collected throughout Turkey from 1983 to 2011. Eur J Clin Microbiol Infect Dis. 2012;31:2783-90.
  • 5. Doganay M, Metan G, Alp E. A review of cutaneous anthrax and its outcome. J Infect Public Health. 2010;3:98-105.
  • 6. Baykam N, Ergonul O, Ulu A, Eren S, Celikbas A, Eroglu M, et al. Characteristics of cutaneous anthrax in Turkey. J Infect Dev Ctries. 2009;3:599-603.
  • 7. Demirdag K, Ozden M, Saral Y, Kalkan A, Kilic SS, Özdarendeli A. Cutaneous anthrax in adults: a review of 25 cases in the eastern Anatolian region of Turkey. Infection. 2003;31:327-30.
  • 8. Mechanical transmission of Bacillus anthracis by stable flies (Stomoxys calcitrans) and mosquitoes (Aedes aegypti and Aedes taeniorhynchus). M J Turell, G B Knudson. Infect Immun. 1987; 55:1859–61.
  • 9. Özden K, Özkurt Z, Erol S, Uyanık MH, Parlak M. Cutaneous anthrax patients in Eastern Anatolia, Turkey a review of 44 adults cases. Turk J Med Sci. 2012;42:39-45.
  • 10. Meriç M, Willke A. Gebze'de şarbon. İnfeksiyon Derg. 2008;22:1-9.
  • 11. Kaya A, Tasyaran MA, Erol S, Ozkurt Z, Ozkan B. Anthrax in adults and children: a review of 132 cases in Turkey. Eur J Clin Microbiol Infect Dis. 2002;21:258-61.
  • 12. Centers for Disease Control and Prevention. Human anthrax associated with an epizootic among livestock-North Dakota, 2000. MMWR Morb Mortal Wkly Rep. 2001;50:677-80.
  • 13. Bartlett JG, Inglesby TV, Borio L. Management of anthrax. Clin Infect Dis. 2002;35:851-8.
  • 14. Bryskier A. Bacillus anthracis and antibacterial agents. Clin Microbiol Infect. 2002;8:467-78.
  • 15. Bakici MZ, Elaldi N, Bakir M, Dökmetaş I, Erandaç M, Turan M. Antimicrobial susceptibility of Bacillus anthracis in an endemic area. Scand J Infect Dis. 2002;34:564-6.
  • 16. Perçin D. Şarbon basillerinde antibiyotik direnci. ANKEM Derg. 2011;25:97-9.
  • 17. Erdem MG, Cil EO, Tukek T, Helvaci SA. Evaluation of platelet and mean platelet volume levels in patients with liver cirrhosis. Arch Clin Exp Med. 2018;3:18-21.
  • 18. Ortatatli M, Karagoz A, Percin D, Kenar L, Kilic S, Durmaz R. Antimicrobial susceptibility and molecular subtyping of 55 Turkish Bacillus anthracis strains using 25-loci multiple-locus VNTR analysis. Comp Immunol Microbiol Infect Dis. 2012;35:355-61.
  • 19. Keim P, Price LB, Klevytska AM et al. Multiple-locus variable-number tandem repeat analysis reveals genetic relationships within Bacillus anthracis. J Bacteriol. 2000;182:2928-36.
  • 20. Keim P, Van Ert MN, Pearson T, Vogler AJ, Huynh LY, Wagner DM. Anthrax molecular epidemiology and forensics: using the appropriate marker for different evolutionary scales. Infect Genet Evol. 2004;4:205-13.

Şarbon’un sepsis ile seyrettiği nadir görülen bir durum: Bir olgu sunumu

Year 2018, Volume:3 Issue: 3, 210 - 213, 30.11.2018
https://doi.org/10.25000/acem.457035

Abstract

Şarbon, Bacillus anthracis'in etken olduğu zoonotik bir hastalıktır. Ülkemizde hastalığın insidansı genel olarak azalmakla birlikte belirli bölgelerde halen endemik olarak görülmektedir. Hastalığın en sık görülen klinik formu deri şarbonu olup, genellikle selim seyreder, bakteriyemi ve sepsis tablosu nadirdir. Bu çalışmada, yara ve kan kültürlerinden etkenin izole edildiği sepsis ile seyreden bir deri şarbonu olgusu sunulmuştur. 

Türkiye’nin Doğu Anadolu bölgesinde yer alan Kars’ta yaşayan 39 yaşındaki bir erkek hasta ateş, üşüme, titreme, sağ kolda yara ve kızarıklık şikayetleriyle başvurdu. Öyküsünde, 3 gün önce sağ kolunu bir böcek (sinek) ısırdığı ve bu ısırık sonrası bir yara geliştiğini bildirdi. Ayrıca hasta bundan 10 gün önce de bir kuzu kestiğini  ifade etti. Hastanın başvuru anında sağ ön kolda 2-3 cm büyüklükte, ortası nekrotik ve ödemli bir lezyon saptandı. Bunun yanında hastanın sağ kolunda ellerden başlayıp omuz seviyesine kadar çıkan ısı artışı, kızarıklık ve ödem mevcuttu. Deri şarbonu ön tanısıyla yatırılan hastaya ampisilin-sulbaktam tedavisi başlandı ancak lezyonlarda kötüleşme ve yayılma olması üzerine tedavisi piperasilin-tazobaktam ve klindamisin olarak değiştirildi. Hastanın lezyonundan gönderilen sürüntü örneklerinin Gram boyasında Gram pozitif sporlu basiller görüldü ve takibinde kan kültürlerinde üreme saptandı. Kan kültürlerinden ve yara sürüntülerinden yapılan Gram boyalarla etken patojen olarak B. anthracis tanımlandı ve yapılan antibiyogramda penisiline duyarlı bulundu. Genotipleme için 25 lokuslu MLVA metodu kullanıldı ve bizim olgumuzdaki genotipin ana küme A ve alt küme 3'te yer alan GK43 olduğu belirlendi. Hospitalizasyonun onuncu gününde kolundaki geniş ve nekrotik lezyonlar nedeniyle hastada kompartman sendromu gelişti; tedavisi amacıyla eskarotomi uygulandı. Üç hafta süren antibiyoterapi ardından hasta şifa ile hastaneden taburcu edildi.

Sonuç olarak, deri şarbonu genel olarak antibiyotik tedavisi ile
iyileşen bir hastalık olmasına rağmen nadir de olsa sepsisle karakterize mortal
bir tabloya dönüşebileceği göz önünde bulundurulmalıdır.

References

  • 1. Doganay M. Anthrax. In: Cohen J, Powderly WG, Opal S (eds), Infectious Diseases. 2010, 3rd ed. Mosby-Elsevier, 2010:1257-61.
  • 2. Lucey D. Bacillus anhtracis (Anthrax). In: Mandell GL, Bennett JE, Dolin R (eds), Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 6th ed. Churchill Livingstone, 2005:2485-93.
  • 3. Ertek M. Şarbonun ülkemizdeki durumu. ANKEM Derg. 2011;25:88-91.
  • 4. Durmaz R, Doganay M, Sahin M, Percin D, Karahocagil MK, Kayabas U, et al. Molecular epidemiology of the Bacillus anthracis isolates collected throughout Turkey from 1983 to 2011. Eur J Clin Microbiol Infect Dis. 2012;31:2783-90.
  • 5. Doganay M, Metan G, Alp E. A review of cutaneous anthrax and its outcome. J Infect Public Health. 2010;3:98-105.
  • 6. Baykam N, Ergonul O, Ulu A, Eren S, Celikbas A, Eroglu M, et al. Characteristics of cutaneous anthrax in Turkey. J Infect Dev Ctries. 2009;3:599-603.
  • 7. Demirdag K, Ozden M, Saral Y, Kalkan A, Kilic SS, Özdarendeli A. Cutaneous anthrax in adults: a review of 25 cases in the eastern Anatolian region of Turkey. Infection. 2003;31:327-30.
  • 8. Mechanical transmission of Bacillus anthracis by stable flies (Stomoxys calcitrans) and mosquitoes (Aedes aegypti and Aedes taeniorhynchus). M J Turell, G B Knudson. Infect Immun. 1987; 55:1859–61.
  • 9. Özden K, Özkurt Z, Erol S, Uyanık MH, Parlak M. Cutaneous anthrax patients in Eastern Anatolia, Turkey a review of 44 adults cases. Turk J Med Sci. 2012;42:39-45.
  • 10. Meriç M, Willke A. Gebze'de şarbon. İnfeksiyon Derg. 2008;22:1-9.
  • 11. Kaya A, Tasyaran MA, Erol S, Ozkurt Z, Ozkan B. Anthrax in adults and children: a review of 132 cases in Turkey. Eur J Clin Microbiol Infect Dis. 2002;21:258-61.
  • 12. Centers for Disease Control and Prevention. Human anthrax associated with an epizootic among livestock-North Dakota, 2000. MMWR Morb Mortal Wkly Rep. 2001;50:677-80.
  • 13. Bartlett JG, Inglesby TV, Borio L. Management of anthrax. Clin Infect Dis. 2002;35:851-8.
  • 14. Bryskier A. Bacillus anthracis and antibacterial agents. Clin Microbiol Infect. 2002;8:467-78.
  • 15. Bakici MZ, Elaldi N, Bakir M, Dökmetaş I, Erandaç M, Turan M. Antimicrobial susceptibility of Bacillus anthracis in an endemic area. Scand J Infect Dis. 2002;34:564-6.
  • 16. Perçin D. Şarbon basillerinde antibiyotik direnci. ANKEM Derg. 2011;25:97-9.
  • 17. Erdem MG, Cil EO, Tukek T, Helvaci SA. Evaluation of platelet and mean platelet volume levels in patients with liver cirrhosis. Arch Clin Exp Med. 2018;3:18-21.
  • 18. Ortatatli M, Karagoz A, Percin D, Kenar L, Kilic S, Durmaz R. Antimicrobial susceptibility and molecular subtyping of 55 Turkish Bacillus anthracis strains using 25-loci multiple-locus VNTR analysis. Comp Immunol Microbiol Infect Dis. 2012;35:355-61.
  • 19. Keim P, Price LB, Klevytska AM et al. Multiple-locus variable-number tandem repeat analysis reveals genetic relationships within Bacillus anthracis. J Bacteriol. 2000;182:2928-36.
  • 20. Keim P, Van Ert MN, Pearson T, Vogler AJ, Huynh LY, Wagner DM. Anthrax molecular epidemiology and forensics: using the appropriate marker for different evolutionary scales. Infect Genet Evol. 2004;4:205-13.
There are 20 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Case Report
Authors

Mahmut Dülger 0000-0001-9179-5598

Kenan Murat This is me 0000-0002-7725-9016

Publication Date November 30, 2018
Published in Issue Year 2018 Volume:3 Issue: 3

Cite

Vancouver Dülger M, Murat K. A rare presentation of anthrax with sepsis: A case report. Arch Clin Exp Med. 2018;3(3):210-3.