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Background: Although anthrax is a rare zoonotic infection, it still causes significant mortality and morbidity. In this multicenter study, which is the largest anthrax case series ever reported, we aimed to describe the factors leading to dissemination of cutaneous anthrax. Methods: Adult patients with cutaneous anthrax from 16 referral centers were pooled. The study had a retrospective design, and included patients treated between January 1, 1990 and December 1, 2019. Probable, and confirmed cases based upon CDC anthrax 2018 case definition were included in the study. A descriptive statistical analysis was performed for all variables. Results: A total of 141 cutaneous anthrax patients were included. Of these, 105 (74%) patients had probable and 36 (26%) had confirmed diagnosis. Anthrax meningitis and bacteremia occurred in three and six patients, respectively. Sequelae were observed in three patients: cicatricial ectropion followed by ocular anthrax (n = 2) and movement restriction on the left hand after surgical intervention (n = 1). One patient had gastrointestinal anthrax. The parameters related to poor outcome (p < 0.05) were fever, anorexia, hypoxia, malaise/fatigue, cellulitis, fasciitis, lymphadenopathy, leukocytosis, high CRP and creatinine levels, longer duration of antimicrobial therapy, and combined therapy. The last two were seemingly the consequences of dissemination rather than being the reasons. The fatality rate was 1.4%. Conclusions: Rapid identification of anthrax is crucial for prompt and effective treatment. Systemic symptoms, disseminated local infection, and high inflammatory markers should alert the treating physicians for the dissemination of the disease.
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OBJECTIVES: Currently, there are limited data on the prevalence of HBsAg in Bosnia and Herzegovina. This study aimed to evaluate the trend of HBsAg prevalence during a period of 20 years in relation to the implementation of pre-donation questionnaires based on parenteral and sexual risk factors and mandatory HBV vaccination. MATERIAL AND METHODS: This is a retrospective analysis performed on 67,336 blood donors at the University Clinical Hospital Mostar during three distinct periods: before introducing of mandatory HBV vaccination and pre-donation blood donor questionnaires (1998-2002); after introducing of pre-donation blood donor questionnaires, but without mandatory immunized blood donors (2004-2008); and after introducing of mandatory pre-donation blood donor questionnaires and mandatory vaccination (2015-2019). RESULTS: According to implementation of mandatory pre-donation blood donor questionnaires and mandatory HBV vaccination the prevalence of HBsAg significantly decreased among blood donors in all three studied periods of time (0.303% in 1998-2002, 0.236% in 2004-2008, and 0.021% in 2015-2019; P<0.001). Out of 67,336 tested donors, there were 98 (0.145%) HBsAg-positive donors during analysed periods, with a mean age of 34.76±11.37 years. The mean age of HBsAg-positive donors was 30.72±10.40, 37.56±10.13, and 47.28±12.14) in the 1998-2002, 2004-2008, and 2015-2019 periods, respectively (P<0.001). CONCLUSION: This study clearly shows a decreased rate of HBV infections among blood donors with respect to implementation of the HBV vaccination schedule and mandatory pre-donation blood donor questionnaires based on parenteral and sexual risk factors.
