Injectional anthrax at a Scottish district general hospital.

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Background:

• Injectional anthrax (IA) is a rare but severe form of anthrax, primarily associated with injecting drug use.
• Previous reports indicate high mortality and morbidity rates, including limb amputation.
• Limited data exists on the clinical presentation and management of IA from single-center experiences.

Purpose of the Study:

• To describe the clinical features, laboratory findings, and management of IA cases.
• To report outcomes and identify factors associated with patient survival and recovery.
• To highlight the largest single-center case series of IA.

Main Methods:

• Retrospective, descriptive case series.
• Review of 21 patients diagnosed with confirmed, probable, or possible IA based on standardized definitions.
• Analysis of clinical presentations, laboratory results, treatment regimens, and patient outcomes.

Main Results:

• All 21 patients survived, with no cases requiring limb amputation, contrasting with higher reported mortality rates.
• Presentations ranged from mild soft tissue infections managed with oral antibiotics to severe cases with organ failure and coagulopathy.
• Daptomycin was used successfully in treating human anthrax; specific biochemical and hematological parameters aided in identifying deteriorating patients.

Conclusions:

• IA can be managed successfully with appropriate medical and surgical interventions, leading to survival and limb preservation.
• Early recognition of clinical and laboratory markers is crucial for timely and intensive management.
• This series contributes valuable insights into the spectrum of IA and its treatment, including novel antibiotic use.