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Rare Anthrax case of pneumonia in the USA

3 de setembro de 2011

Baccillus Anthrax

Rare Anthrax case of pneumonia in the USA

(PULMAOSANEWS) – Orlando, FL – The Center for Disease Control and Prevention (CDC) of the United States reported the existence of a case of pneumonia due to anthrax in a patient of 61 years from St. Petersburg, Florida, on vacation by State of Wyoming, Montana and the Dakotas, which occurred on August 3, 2011.

Anthrax

It is an acute toxiinfection caused by a gram positive, worldwide occurrence, Bacillus anthracis, which usually attacks the skin and rarely the nasopharynx, the lower airways, or the mediastinum and intestine.

Anthrax Cutaneous Presentation

Cutaneous presentation

The cutaneous form is the most common and manifests itself initially by itching of the skin exposed to the agent followed by the appearance of confluent lesions: papules, pustules, vesicles and painless ulcers that in two to six days can turn into blackened scars.
The most common sites of infection are the head and hands. When not treated spreads to regional lymph nodes and the bloodstream, and can occur septicemia. The mortality of untreated cutaneous form can reach 50 to 20%.

Inhalation presentation

According to PULMAOSA’S medical advisor, Dr. Marcos Nascimento, the respiratory form as presented by the patient is extremely rare and often lethal( varying mortality rates of 45%, as in cases of 2001, up 80% as described outbreak in Russia in 1979).
Initial symptoms are nonspecific and resemble an superiors respiratory infection (SRI). However it can progress rapidly to respiratory failure, with radiological signs of involvement of mediastinal lymph nodes (mediastinal widening), associated with fever, shock and imminent risk of death. The bacillus can remain in their vegetative form in the soil where it should have been inhaled by the patient in question, in an interval of 24 hours a week which is the incubation period of this germ, complements Dr. Nascimento.

Intestinal presentation

The intestinal variant, acquired by ingesting contaminated meat from herbivores is rare and more difficult to be identified, except when there is epidemiologic links. It is characterized by abdominal discomfort, vomiting, fever, diarrhea that progresses to
bloody, acute abdomen, signs of sepsis and death.

Anthrax Cycle

Epidemiology

The man is an accidental host and the incidence is very low and often sporadic in most of the world. We must remember that it is an occupational hazard for workers who handle animals and their products. Some cases were reported in South America and Central Asia and Africa. In 2001,there were cases in the United States of America that has been allocated to biological warfare.

DIAGNOSIS

Suspected clinical and epidemiological;
Laboratory: 1. isolation of Bacillus anthracis in the blood, injury, secretions, or tissues (histology);
2. And blood tests for antibodies by immunofluorescence.

TREATMENT

This patient was initially treated with antibiotic coverage for community-acquired pneumonia requiring hospitalization (≥ 2 CURB criteria). But how they managed to isolate the Bacillus anthracis, He was treated with a combination of ciprofloxacin associated with anti-Anthrax Immunoglobulin (anti-bodies produced from the serum of persons vaccinated for anthrax to combat the toxin of the bacillus).
The CDC recommends the use of ciprofloxacin, given the strength associated with B-lactamers as amoxicillin and cephalosporins, both resistence were found in bacilli from soil and in the recorded cases of 2001 terrorist’s attacks.
The duration of treatment with ciprofloxacin should be for 60 days.

PS. The patient was discharged this August 30. Maybe the patient may have some lingering effects for a few weeks or longer, but he will recover fully in time.

SOURCES:

PULMAOSANEWS-Lung S /A: Your atmosphere, Your Life! ®

CDC-Centers for Disease Control USA

Brazil, Ministry of Health

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