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Injectional anthrax - new presentation of an old disease.
T Berger1, M Kassirer, A A Aran
1Israel Defense Force, Medical Corps, Ramat-Gan, Israel.
Summary
Injectional anthrax, a novel manifestation of Bacillus anthracis infection among European heroin users, presents unique severe soft tissue infections. Increased clinician awareness is crucial for early diagnosis and improved patient outcomes.
Area of Science:
- Infectious Diseases
- Public Health
- Microbiology
Background:
- Bacillus anthracis causes anthrax with distinct clinical forms: cutaneous, gastrointestinal, and inhalational.
- Since 2009, a novel 'injectional anthrax' has emerged among European heroin users, linked to contaminated heroin.
- This form presents differently from traditional anthrax and has a high fatality rate.
Purpose of the Study:
- To comprehensively review literature and reporting systems on injectional anthrax cases until December 2013.
- To highlight the unique clinical characteristics and diagnostic challenges of injectional anthrax.
- To emphasize the importance of clinician awareness for timely management.
Main Methods:
- Comprehensive literature review.
- Analysis of data from various reporting systems up to December 31, 2013.
- Review of published case reports focusing on clinical presentation and outcomes.
Main Results:
- A total of 70 confirmed injectional anthrax cases were reported, with a 37% case fatality rate (26 deaths).
- Thirteen case reports described 18 cases, with 16 presenting severe soft tissue infections distinct from cutaneous anthrax.
- Diagnosis was delayed by 3-12 days due to unfamiliar characteristics, leading to inadequate treatment and high mortality.
Conclusions:
- Injectional anthrax is a significant clinical entity with a high fatality rate.
- Delayed diagnosis and treatment due to atypical presentation contribute to poor outcomes.
- Enhanced clinician awareness of this emerging infection is essential for effective patient management.
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