Two cases of progressive cutaneous anthrax described
Hai-Ling Yuan, from Lanzhou General Hospital in China, and colleagues present two cases of human cutaneous anthrax that began in the right forearm and progressed. The patients were both bitten by mosquitos—one while in contact with a sick cow and the other while slaughtering infected cattle.
The authors note that the first patient had a red pustule on his forearm, which swelled and blistered. After admission, he received penicillin G; magnesium isoglycyrrhizinate was added following elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The edema on the patient's hand did not totally regress at the fourth week of therapy and a black eschar remained. The second patient developed a small erythema lesion with itching, which worsened to a wound, causing swelling and multiple bullae. He received cephalosporin antibiotics. Following further testing that revealed elevated white blood cell count, C-reactive protein, and AST and ALT, the patient was given penicillin G, levofloxacin, and methylprednisolone; glycyrrhizin was also added. The edema on the patient's arm completely resolved after treatment for four weeks, but there was still edema on the hand.
"Clinical and experimental comparative studies are needed for steroid therapy and the duration of antibiotic therapy in complicated cases of naturally acquired cutaneous anthrax," the authors write.
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