Investigation report on an outbreak of cutaneous anthrax in Caoxian County, Heze City, Shandong Province in 2021 / 中华地方病学杂志

Objective:To analyze the cause and epidemiological characteristics of an outbreak of cutaneous anthrax in Caoxian County, Heze City, Shandong Province, and to provide scientific basis for anthrax prevention and control.Methods:Using on-site epidemiological investigation methods and the "Anthrax Epidemiological Case Investigation Form", case investigations were conducted based on the epidemiological contact history and close contacts of suspected anthrax cases reported by the national health care system ( n = 83). Scorched skin smears, diseased cattle tissues, soil samples from the slaughter site and smears from slaughter utensils were collected from cases for Real-time PCR testing and pathogenic bacteria isolation and culture, respectively. Anthrax determination criteria were carried out with reference to "Anthrax Diagnosis" (WS 283-2020). Results:A total of 13 cases of cutaneous anthrax were found in this outbreak, including 12 clinically diagnosed cases and one confirmed case (positive Real-time PCR test and isolation of a strain of Bacillus anthracis). The epidemiological investigation determined that the source of infection in this outbreak was diseased cattle, the transmission route was through slaughter of diseased cattle, contact with contaminated utensils and related cattle products, and the patients were mainly engaged in occupations related to cattle slaughter or cattle product collection and sale. A total of 84 samples were collected, including 13 skin scabs, 64 environmental samples and 7 beef samples. Thirty-six positive PCR tests were performed, with a positive rate of 42.86% (36/84). Among them, 100.00% (13/13) were positive for skin scab smear specimens, 29.69% (19/64) for environmental samples and 4/7 for beef samples. A total of 8 strains of Bacillus anthracis were isolated, including 6 environmental specimens, 1 suspected case and 1 beef strain, with an overall detection rate of 9.52% (8/84). Eighty-three close contacts were investigated. Thirteen households involved in the epidemic were disinfected by spraying (200 ml/m 2) with chlorine-containing disinfectant (5 000 mg/L), and a total of 40 households involved in the epidemic were disinfected, covering an area of about 10 765 m 2. Forty-five pieces of suspected contaminated clothing were burned and disposed of, and 152 pieces of kitchenware were soaked. Conclusions:Slaughter of infected cattle, contact with contaminated utensils and related cattle products are the main causes of this skin anthrax outbreak. Strengthening market supervision, deepening inter-animal epidemic prevention, carrying out publicity and education on anthrax prevention and control, and enhancing practitioners' awareness of disease prevention is the key to prevent anthrax from occurring.

Epidemiological investigation of an outbreak of anthrax in Gongliu County, Xinjiang Uygur Autonomous Region / 预防医学

Abstract@#A suspected case of cutaneous anthrax was reported by Gongliu County Disease Control and Prevention Center, Ili Kazak Autonomous Prefecture, Xinjiang Uygur Autonomous Region on August 19, 2021. Then, an epidemiological survey was performed by a joint investigation team consisting of professionals from Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, intermediate-level trainees from the Field Epidemiology Training Program of Chinese Center for Disease Control and Prevention, and professionals from Ili Kazak Autonomous Prefecture Center for Disease Control and Prevention. A total of 11 cutaneous anthrax cases were identified, including 8 suspected cases and 3 clinically diagnosed cases, and all cases were villagers in Y Village, X Township, Gongliu County, without severe case or deaths found. The onset of the first case occurred on July 27, and the onset of the last case occurred on August 16. The main clinical manifestations included ulcerative eschar on hands and exposed skin of the upper extremity. A Bacillus anthracis isolate was detected in meat samples from infected cattle. Epidemiological surveys showed that villagers did not report infected cattle to related sectors and privately slaughtered and ate meat from infected cattle without any effective protective measures, resulting in this outbreak. It is recommended to strengthen health education for people raising, selling and slaughtering livestock, and publicize zoonotic disease control knowledge, including anthrax, and establish an effective surveillance and response system for anthrax for immediate identification and treatment of epidemics.

Sporadic human cutaneous anthrax outbreak in Shaanxi Province, China: report of two cases from 2018

ABSTRACT China's compulsory annual livestock anthrax vaccination policy has remarkably reduced but not completely eradicated human anthrax infections. Herein we describe a sporadic human cutaneous anthrax outbreak involving two cases in 2018 in Shaanxi Province, both involving herdsman who dealt with unvaccinated and potentially sick cattle. Both patients showed Bacillus anthracis-positive blister smear and blood culture. Treatment with penicillin was followed by uneventful recovery for both. The prompt performance of the prophylactic measures successfully interrupted the further transmission of this sporadic human cutaneous anthrax outbreak.

Spatial distribution of cutaneous anthrax in western Iran from 2009 to 2016: Geographic information system mapping for predicting risk of anthrax outbreaks

To explore the spatial accumulation of diseases and their aggravating factors are essential in all public health. This study attempts to use geographic information system (GIS) to provide more information about the incidence and future of anthrax. Methods: Patients were diagnosed with anthrax in Kurdistan Province from 2009 to 2016. Data was then exported into ArcGIS software version 9 and the required layers for years and areas were added.Final map for each year was drawn up, pointing out the hot spots and predicting its future pattern. Results: Most cases were reported in females (57 cases, 54.80 %), and the lower body limbs were most affected (63 cases, 60.57%). The highest numbers of incidences were related to the cities of Marivan, Saqez and Divandareh, with more concentration in the central parts of the province, rather than borderline areas. The highest percentage of the probable incidence of the disease was in Sanandaj (57.74%) with a potential susceptible area of 1 729.12 km2 and then in Saqez (54.36%) with a potential area of 2 422.4 km2. Conclusions: A vast area of Kurdistan Province is high risk for new cases of anthrax. Therefore, it is important to scale up the surveillance system in the province.

Spatial distribution of cutaneous anthrax in western Iran from 2009 to 2016: Geographic information system mapping for predicting risk of anthrax outbreaks

To explore the spatial accumulation of diseases and their aggravating factors are essential in all public health. This study attempts to use geographic information system (GIS) to provide more information about the incidence and future of anthrax. Methods: Patients were diagnosed with anthrax in Kurdistan Province from 2009 to 2016. Data was then exported into ArcGIS software version 9 and the required layers for years and areas were added.Final map for each year was drawn up, pointing out the hot spots and predicting its future pattern. Results: Most cases were reported in females (57 cases, 54.80 %), and the lower body limbs were most affected (63 cases, 60.57%). The highest numbers of incidences were related to the cities of Marivan, Saqez and Divandareh, with more concentration in the central parts of the province, rather than borderline areas. The highest percentage of the probable incidence of the disease was in Sanandaj (57.74%) with a potential susceptible area of 1 729.12 km

Ántrax cutáneo, último brote diagnosticado en Chile / Cutaneous anthrax, the last outbreak diagnosed in Chile

Resumen El ántrax, es una zoonosis causada por una bacteria generadora de esporas, llamada Bacillus anthracis. En forma natural tiene una distribución global, con una predilección en zonas agrícolas con pocas normativas de sanidad pública veterinaria. El contagio humano ocurre por el consumo de carnes de animales enfermos, por contacto a través de una puerta de entrada en la piel o por la inhalación de esporas de productos derivados del animal afectado (lana, cuero, huesos). La infección en los seres humanos compromete con mayor frecuencia la piel, seguido por el tracto gastrointestinal y los pulmones. El control de la enfermedad se basa en la prevención, de allí la importancia de la vigilancia en la detección de casos y brotes. Presentamos el último brote de ántrax cutáneo diagnosticado en Chile con descripción de dos primeros casos clínicos del brote.

Anthrax is a zoonosis caused by a spore-forming bacterium, called Bacillus anthracis. Naturally it is of global distribution, with a predilection in agricultural zones with few norms of public veterinary health. Human contagion occurs through the consumption of diseased animal's meat or through a doorway into the skin or through the spores inhalation of products derived from the affected animal (wool, leather, bones). The most frequent infection in humans occurs in the skin, followed by the gastrointestinal tract and lungs. We present the last outbreak of cutaneous anthrax diagnosed in Chile with a description of the first two clinical cases of the outbreak. Control disease is based on prevention, hence the importance of surveillance in detecting cases and outbreaks.

An outbreak of cutaneous anthraxcaused by slaughter sick cow in Xinjiang, China, 2016 / 中国人兽共患病学报

On June 6,2016,an outbreak of suspected cutaneous anthrax was reported by T County CDC,Xinjiang Uygur Autonomous,China.An investigation was carried out to determine the magnitude and risk factors and to recommend control measures.Suspected cases were defined as any villager in T county residents whose skin appeared rash,blisters,ulceration,swelling of black eschar or ulcer between May 1 and June 8.Confirmed case were defined as suspected case plus serological positive,real-time polymerase chain reaction (PCR) positive or Bacillus anthraci isolated.We interviewed clinicians and reviewed medical files in the township and city hospital,and visited all households searching for cases.A case-control study was conducted to investigate the risk factors of human anthrax infection.Three types of specimens were collected and tested by serological detection,real-time polymerase chain reaction (PCR) and bacterial culture.Through epidemiological investigation,15 families purchased beef of a sick cow on May 26,2016.Between 29 May and 3 June,ten people from these families were diagnosed as skin anthrax.Among them,six were confirmed cases and four were suspected cases.The attack rate was 20％.The incubation period was 3 to 7 days with average incubation 5 days.The nain clinical manifestations were hand skin anthrax carbuncle.Case control study showed that the incidences of people who exposing or not exposing to contaminated beefs significantly different,with 53％ and 0％ respectively.Blood serums from six patients showed that specific antibody titer appeared to increase more than 4 times.B.anthraci was isolated from herpes fluid of one patient.B.anthraci nucleic acid was detected from beef collected from four families.The outbreak was caused by the villagers exposed sick cow which infected by B.anthraci.Contaminated beef caused the infections.

Ántrax cutáneo complicado con fascitis necrotizante y síndrome compartimental / Cutaneous anthrax complicated by necrotizing fasciitis and compartment syndrome

El ántrax o carbunco cutáneo es una zoonosis producida por el Bacillus anthracis, caracterizado por una úlcera necrótica, indolora, que cura generalmente espontáneamente y sin complicaciones. Presentamos el caso de un paciente varón agroganadero que presentó una úlcera necrótica rodeada de lesiones ampollares serohemáticas en cara ventral del antebrazo derecho y múltiples vesículas satélites purulentas, asociada a un edema extenso y dolor incapacitante del miembro afectado. Al ingreso, los exámenes revelaron leucocitosis (15 000/mL), CPK total (1 730 U/L) y prueba positiva de reacción en cadena de polimerasa (PCR) para Bacillus anthracis. Se diagnosticó síndrome compartimental y se realizó fasciotomía de emergencia. El reporte quirúrgico fue fascitis necrotizante, por finger test. En el seguimiento se evidenció contractura isquémica de Volkmann leve. Se debe plantear como diagnóstico el síndrome compartimental ante el dolor incapacitante, porque nos permitirá una intervención quirúrgica oportuna a fin de evitar perder la extremidad comprometida.

Introduction: Cutaneous anthrax is a zoonosis caused by Bacillus anthracis characterized by painless necrotic ulcer that usually heals spontaneously and without complications. The case of a farmer and cattle breeder male patient who presented a bullous serosanguineous ulcer surrounded by necrotic lesions in the ventral right forearm and multiple purulent satellite vesicles associated with extensive edema and disabling pain in the affected limb is reported. On admission, examinations revealed leukocytosis (15 000/ mL), total CPK (1 730 U/L) and positive test for Bacillus anthracis by polymerase chain reaction (PCR). Compartment syndrome was diagnosed and emergency fasciotomy was performed. Surgical report was necrotizing fasciitis by finger test. Mild Volkmann ischemic contracture was found during follow-up. Diagnosis of compartment syndrome should be considered when disabling pain is present to decide prompt surgical intervention in order to avoid losing the limb involved.

Cases of anthrax caused by ingestion of suspected carabao meat

Six cases of cutaneous anthrax are presented, showing almost identical lesions developing shortly after the ingestion of the meat of a clandestinely slaughtered animal. This animal was reported to have been ill before it was slaughtered. The outbreak of this disease in this isolated barrio could have been prevented if these people had adhered to the local regulation, prohibiting the slaughter of work animals without the permit of the local veterinarianThe common belief that cutaneous anthrax is caused usually by contact with the organism should be revised to include the possibility of ingestion of infected meat playing a distinct part in its etiologyIn the treatment of these cases, the use of penicillin and sulfathiazole may be tried in the absence of the specific anti-anthrax serum. (Summary and Conclusions)