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This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.

Original publication

DOI

10.1017/S0950268814001885

Type

Journal article

Journal

Epidemiol Infect

Publication Date

04/2015

Volume

143

Pages

1311 - 1321

Keywords

soft tissue infections, Adult, Anthrax, Anti-Bacterial Agents, Female, Hospitals, General, Humans, Male, Middle Aged, Retrospective Studies, Scotland, Substance Abuse, Intravenous, Young Adult