Carbunco cutáneo. Más del 95% de las infecciones naturales por. B. anthracis son cutaneas y están relacionadas con la. Palabras clave: carbunco, vacunación . Ántrax cutáneo en Lima, Perú: análisis retrospectivo de 71 casos, incluyendo cuatro .. E. & GUERRA, H. – Carbunco cutáneo en el Perú: revisión y experiencia. 19 Carbunco Manifestaciones clínicas El carbunco cutáneo comienza como una pápula pruriginosa que se agranda, se ulcera y forma una escara central de.
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Cutaneous anthrax in Lima, Peru: Anthrax is a zoonosis produced by Bacillus anthracisand as an human infection is endemic in several areas carbunck the world, including Peru. In this study we review the clinical and epidemiological characteristics of the patients with diagnosis of cutaneous anthrax evaluated between and at the Hospital Nacional Cayetano Heredia HNCH and the Instituto de Medicina Tropical Alexander von Humboldt in Lima, Peru.
The source of infection was found in 63 All the patients had ulcerative lesions, with a central necrosis. In conclusion, considering its clinical and epidemiological characteristics, cutaneous anthrax must be included in the differential diagnosis of skin ulcers. A patient with clinical suspicion of the disease should carbumco effective treatment soon, in order to avoid neurological complications which carry a high fatality rate.
Anthrax; Bacillus anthracis ; Cutaneous anthrax; Anthrax meningitis; Peru. Todos presentaron lesiones ulcerativas con necrosis central.
Cutaneous anthrax is a disease known since ancient times. It was described carbunxo the “malignant plague” by Egyptians and Indians. Hippocrates called the disease “anthrax” from the Greek term cafbunco which means coal, because of the black color of the skin lesion Anthrax is a zoonosis produced by Bacillus anthracis that affects mainly domestic and wild herbivorous animals. Humans are incidental hosts, and are infected through direct or indirect contact with animals or contaminated products 32, Historically, cutaneous anthrax has received other denominations as “carbuncle”, “malignant pustule”, “malignant edema”, and others.
CARBUNCO – Definition and synonyms of carbunco in the Spanish dictionary
Characteristically, chains of bacilli resemble bamboo shoots 5,33, Virulence depends on sporulation 13 and the production of toxins 3,11,25both under genetic control The incidence of cutaneous anthrax is decreasing worldwide However, some endemic areas in Africa, Asia and America, have occasional outbreaks producing serious impact on the health and economy of the population 10,14,20,31,33, In those areas misdiagnosis and sub notification are common problems which make real knowledge of the extent of the disease difficult.
In contrast, in industrial countries the application of good control and monitorization measures have produced great reduction of the disease prevalence and its lethality in humans and cattle 38,39 ; anthrax is now considered a rare occupational disease In the USA, between andcases of cutaneous anthrax were notified, but only five cases occurred between and 7,8.
The initial clinical manifestation of anthrax depends on the way of entrance of the B. All presentations can have complications such as sepsis, meningoencephalitis, and a fatal outcome.
The inhalational form has the highest lethality 15,31, Recently, the bioterrorist attacks in USA indemonstrated the possibility of the use of B. Since Septemberthere have been reported 22 confirmed or suspicious cases, 11 of them acquired by the inhalational and cutaneous form respectively 9.
The modern experience with inhalational anthrax is based on a considerable extent of the outbreak in Sverdlovsk, Russia, after the accidental escape and windborne spread of spores of B. Several studies in Peru showed that cutaneous anthrax has been an important disease since more than one century at least 4,6,26, The last epidemiological summary of the Ministry of Health in Peru reported a national incidence of 0.
The purpose of the present study was to describe the clinical and epidemiological characteristics in Peruvian patients with cutaneous anthrax, including 4 cases with meningoencephalitis. Every patient with a diagnosis of cutaneous anthrax between and were included. This is a descriptive retrospective study.
Medical records were examined, and information regarding clinical aspects, epidemiology and treatment were collected. A suspected case of cutaneous anthrax was defined as a patient with a cutaneous ulcer developing a black scab, in association with a history of direct or indirect contact with an chtaneo animal or its products meat, organs, wool, bones.
A definitive case was a patient with: The definition caarbunco meningoencephalitis due to anthrax required the inclusion of a suspected or definitive case of cutaneous anthrax and: A secondary bacterial infection was defined by finding a purulent secretion in the cutaneous lesion.
The clinical evolution after the treatment was classified into three categories 1 favorable with rapid clinical improvement during the first three post-treatment days; 2 favorable with slow clinical improvement after the third day of treatment; and 3 unfavorable: Data of distribution were calculated using cutanei EpiInfo 6.
Seventy one cases were included, 31 The disease was associated with a direct animal contact: The period of incubation could be calculated in 45 cases, with a mean of 5. The patients were admitted with duration of disease of 6.
The main systemic symptoms were fever Two patients had anisocoria, and one patient had hemiparalysis. The total number of different lesions was The body distribution of the lesions was mainly in the upper limbs Lesions involved just one body area in 48 There was secondary bacterial infection in 15 Fifty eight blood cell counts were analyzed. Bacteriological studies were performed in 51 Direct smear of the ulcer was the ccarbunco common test, and it showed Gram positive bacilli in 27 Culture of lesions found presumably B.
Additionally, among the patients with a purulent secretion, Gram positive cocci or bacilli were found in five carbunfo, and cultures showed one case each of Staphylococcus epidermidisStaphylococcus aureusand Klebsiella species.
Blood cultures were taken in 17 patients, and in two The CSF was purulent in all cases with predominance of ctuaneo Table 3. Two patients had an open pressure reading of more than 20 cm cutane water. One carbunfo had hemorrhagic meningitis, not caused by a traumatic lumbar puncture. Three cases showed Gram positive bacilli and presumably B. In this case, sheep blood agar was used. The drug of choice for outpatients was procaine penicillin IM or PO.
Tetracycline was prescribed in seven 9. The clinical response could be evaluated in 66 One patient was transferred to another hospital and four did not return after discharge. The clinical response was favorable in 63 The majority of patients with favorable response 37, Of the 26 The three patients with unfavorable clinical response had meningoencephalitis and died within 72 hours of admission, in spite of antibiotic treatment and life support measures.
In other words, three of four patients with meningoencephalitis died. The only survived case remained in coma for 10 days. He recovered consciousness 15 days after admission, and had hemiparalysis as a sequel. This patient was discharged 30 days after admission without CNS involvement.
The fatality rate of this series was 4. This study represents the largest Peruvian series of cutaneous anthrax and is a contribution to the identification of some of its clinical and epidemiological characteristics. Cutaneous anthrax is endemic in Peru. Based on the information of the General Office of Epidemiology, Ministry of Health of Peru 26the number of cutaneous anthrax cases is decreasing from per year in the 80’s to less cytaneo 50 cases carbuno. The Lima Norte health area has the highest recorded incidence of animal and cabunco anthrax in Peru.
The number of cases in the HNCH hospital has also decreased during the last years.
The probable reasons are the progressive urbanization process, and the increased vaccination efforts on the part of the cattle raisers in the endemic rural portion of the extensive catchment area of the Hospital.
The most cases of this series were reported during the summer season January-May. This relation between number of cases and ecologic conditions has been previously reported in Peru 6,28 and other countries of Asia and Africa 10,14,31, Many reports associate outbreaks of human anthrax with cases in cattle 4,6,14,28, In this study this association could also be observed.
The manipulation of dead livestock is a risk factor for anthrax. This is conditioned by the absence of technical supervision and the illegal covert commercialization of meat, sometimes coming from sick animals.
Contrary to the African and Asiatic reports 14,31,36where the riskier occupation is cattle raising, the main occupation of Peruvian patients with cutaneous anthrax is agriculture 4,6,21, In Peru, like in other Andean countries, many farmers also own a few domestic animals cows, goats and pigs. Anthrax presents diverse infection mechanisms. After entering the organism through skin lesions, inhalation or ingestion, the spores of the B.
The spores germinate in the macrophages and become vegetative bacteria, which multiply, destroy the macrophages and invade the lymphatic system, finally reaching the blood circulation 3.
The main virulence factors of B. One of them codes for the polyglutamyl phagocytosis-inhibiting capsule of the vegetative bacteria, and the other one carries the genes for toxin synthesis. The main toxins, denominated edema toxin and lethal toxin, are binary compounds Both have a common protein, component B, which is necessary for entrance of the toxin into the guest’s cells. Component A of edema toxin is edema factor, an adenylate-dependent calmodulin cyclase that is responsible for the often impressive local edema, neutrophil inhibition and stimulation of monocytes for production of tumoral necrosis factor and interleukin 6.
In the case of meningeal involvement, the anatomo-pathological events depend on these toxins, which cause hemorrhage and edema In the cases of inhalational anthrax, characterized by hemorrhagic throraxic lymphadenitis and hemorrhagic mediastinitis, the toxins cause severe inflammation and necrosis The incubation period of cutaneous anthrax is usually from two to seven days, but reports on the beginning of clinical manifestations establish a period from nine hours up to eight weeks after the infecting contact