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1994-08-09
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Document 0068
DOCN M9480068
TI [Visceral form of human anthrax imported from Africa]
DT 9410
AU Paulet R; Caussin C; Coudray JM; Selcer D; de Rohan Chabot P; CHG,
Longjumeau.
SO Presse Med. 1994 Mar 12;23(10):477-8. Unique Identifier : AIDSLINE
MED/94294309
AB Widespread vaccination has largely eliminated anthrax in Europe (the
last case was reported in France in 1972) but the disease remains
endemic in many developing countries. The usual cutaneous presentation
(malignant pustules) is much more familiar than the various visceral
manifestations including digestive tract, pulmonary or meningeal signs.
We report a case of a 33-year-old immigrant living in France who was
hospitalized for asthenia, dyspnoea, mucopurulant expectoration and
moderate diarrhoea 3 days after a 3-month stay in Senegal and Gambia.
The temperature was 39 degrees C at admission and blood pressure 110/70
mmHg. Crepitants were heard at the base of the right lung and the rest
of the physical examination was normal. Blood was drawn for culture.
Laboratory tests and the chest X-ray led to the diagnosis of pneumopathy
and a treatment of amoxicillin and clavulanic acid was given with
oxygenotherapy. The patient's temperature returned to normal but over
the next 48 hours the dyspnoea worsened together with the black
diarrhoea. The abdomen was painful. There were no skin lesions. The
chest X-ray revealed an extension of the bilateral pulmonary images and
bilateral pleural effusion. Laboratory tests revealed thrombopenia
(platelet count 38,000/mm3) hyperleukocytosis (WBC 48,000/mm3) and
haemolysis (Hb 4 milligrams). The diagnosis was made on the basis of the
initial blood cultures which were positive for Bacillus anthracis. All
other samples were negative, including HIV serology. Despite adapted
antibiotic therapy (penicillin G, 8MU/day, was initiated on day 2),
multiple organ failure occurred with septic shock and pulmonary oedema.
The patient died in the intensive care unit on day 7. Fatal outcome due
to anthrax is described in 25% of the visceral forms but reaches 100% in
cases of septicaemia. The haemolysis observed in this case is not
mentioned in the classical descriptions of anthrax. When treating septic
syndromes in patients who have returned from endemic zones, clinicians
should entertain the diagnosis of anthrax since the risk of fatal
outcome is increased greatly in case of delayed diagnosis.
DE Adult Anthrax/DIAGNOSIS/*MICROBIOLOGY Case Report English Abstract
Fatal Outcome Food Microbiology Food Poisoning/MICROBIOLOGY France
Gambia/EPIDEMIOLOGY Gastrointestinal Diseases/ETIOLOGY/MICROBIOLOGY
Human Lung Diseases/DIAGNOSIS/ETIOLOGY/*MICROBIOLOGY Male
Meat/MICROBIOLOGY Senegal/EPIDEMIOLOGY JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).