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Doganay M, Dinc G, Kutmanova A, Baillie L. Human Anthrax: Update of the Diagnosis and Treatment. Diagnostics (Basel) 2023; 13:diagnostics13061056. [PMID: 36980364 PMCID: PMC10046981 DOI: 10.3390/diagnostics13061056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Anthrax is one of the most important zoonotic diseases which primarily infects herbivores and occasionally humans. The etiological agent is Bacillus anthracis which is a Gram-positive, aerobic, spore-forming, nonmotile, rod-shaped bacillus. The spores are resistant to environmental conditions and remain viable for a long time in contaminated soil, which is the main reservoir for wild and domestic mammals. Infections still occur in low-income countries where they cause suffering and economic hardship. Humans are infected by contact with ill or dead animals, contaminated animal products, directly exposed to the spores in the environment or spores released as a consequence of a bioterrorist event. Three classical clinical forms of the disease, cutaneous, gastrointestinal and inhalation, are seen, all of which can potentially lead to sepsis or meningitis. A new clinical form in drug users has been described recently and named “injectional anthrax” with high mortality (>33%). The symptoms of anthrax in the early stage mimics many diseases and as a consequence it is important to confirm the diagnosis using a bacterial culture or a molecular test. With regards to treatment, human isolates are generally susceptible to most antibiotics with penicillin G and amoxicillin as the first choice, and ciprofloxacin and doxycycline serving as alternatives. A combination of one or more antibiotics is suggested in systemic anthrax. Controlling anthrax in humans depends primarily on effective control of the disease in animals. Spore vaccines are used in veterinary service, and an acellular vaccine is available for humans but its use is limited.
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Affiliation(s)
- Mehmet Doganay
- Department of Infectious Diseases, Faculty of Medicine, Lokman Hekim University, 06510 Ankara, Turkey
- Correspondence:
| | - Gokcen Dinc
- Department of Medical Microbiology, Faculty of Medicine, Erciyes University, 38039 Kayseri, Turkey;
- Department of Molecular Microbiology, Genome and Stem Cell Center, Erciyes University, 38280 Kayseri, Turkey
| | - Ainura Kutmanova
- Department of Infectious Diseases, International Higher School of Medicine, Bishkek 720010, Kyrgyzstan;
| | - Les Baillie
- School of Pharmacy and Pharmaceutical Science, College of Biomedical and Life Sciences, Cardiff University, Cardiff CF10 3NB, UK;
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Kutmanova A, Zholdoshev S, Roguski KM, Sholpanbay uulu M, Person MK, Cook R, Bugrysheva J, Nadol P, Buranchieva A, Imanbaeva L, Dzhangazieva A, Bower WA, Hendricks K. Risk Factors for Severe Cutaneous Anthrax in a Retrospective Case Series and Use of a Clinical Algorithm to Identify Likely Meningitis and Evaluate Treatment Outcomes, Kyrgyz Republic, 2005-2012. Clin Infect Dis 2022; 75:S478-S486. [PMID: 36251556 PMCID: PMC9649429 DOI: 10.1093/cid/ciac537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND US Centers for Disease Control and Prevention guidelines currently recommend triple-therapy antimicrobial treatment for anthrax meningitis. In the Kyrgyz Republic, a country with endemic anthrax, cutaneous anthrax patients are routinely hospitalized and treated successfully with only monotherapy or dual therapy. Clinical algorithms have been developed to identify patients with likely anthrax meningitis based on signs and symptoms alone. We sought to retrospectively identify likely meningitis patients in the Kyrgyz Republic using a clinical algorithm and evaluate risk factors and their outcomes by type of treatment. METHODS We conducted a retrospective chart review of cutaneous anthrax patients in the Kyrgyz Republic from 2005 through 2012. Using previous methods, we developed a highly specific algorithm to categorize patients by meningitis status. We then evaluated patient risk factors, treatments, and outcomes by disease severity and meningitis status. RESULTS We categorized 37 of 230 cutaneous anthrax patients as likely having meningitis. All 37 likely meningitis patients survived, receiving only mono- or dual-therapy antimicrobials. We identified underlying medical conditions, such as obesity, hypertension, and chronic obstructive pulmonary disease, and tobacco and alcohol use, as potential risk factors for severe anthrax and anthrax meningitis. CONCLUSIONS Based on our analyses, treatment of anthrax meningitis may not require 3 antimicrobials, which could impact future anthrax treatment recommendations. In addition, chronic comorbidities may increase risk for severe anthrax and anthrax meningitis. Future research should further investigate potential risk factors for severe anthrax and their impact on laboratory-confirmed meningitis and evaluate mono- and dual-therapy antimicrobial regimens for anthrax meningitis.
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Affiliation(s)
- Ainura Kutmanova
- Correspondence: A. Kutmanova, PhD, Department of Infectious Diseases, International Higher School of Medicine, 720054 Bishkek, Kyrgyz Republic ()
| | - Saparbai Zholdoshev
- Department of Epidemiology, Microbiology with a course of Infectious Diseases, Osh State University, Osh, Kyrgyz Republic
| | - Katherine M Roguski
- Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melis Sholpanbay uulu
- Department of Infectious Diseases, Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic
| | - Marissa K Person
- Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel Cook
- Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julia Bugrysheva
- Division of Preparedness and Emerging Infections, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick Nadol
- CDC Kyrgyzstan, US Centers for Disease Control and Prevention, Bishkek, Kyrgyz Republic
| | - Aisuluu Buranchieva
- Department of Infectious Diseases, International Higher School of Medicine, Bishkek, Kyrgyz Republic
| | - Lira Imanbaeva
- Department of Infectious Diseases, International Higher School of Medicine, Bishkek, Kyrgyz Republic
| | - Ainura Dzhangazieva
- Department of Infectious Diseases, International Higher School of Medicine, Bishkek, Kyrgyz Republic
| | - William A Bower
- Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Hendricks
- Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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