Evaluation of the anthraxin skin test for diagnosis of acute and past human anthrax

Shlyakhov, E. N.; Rubinstein, Ethan

doi:10.1007/bf01591362

Cited by 31 publications

(17 citation statements)

References 3 publications

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“…The clinical diagnosis of cutaneous anthrax is traditionally established by microbiological methods like demonstrating Gram-positive, capsulated bacilli on the smear of the lesion or isolating B. anthracis in culture (2,24). However, Gram staining and culture for B. anthracis can be unrevealing for patients who have received antibiotic therapy before the collection of samples (23). Moreover, cutaneous anthrax lesions are very difficult to discriminate from many other skin infections.…”

Section: Discussionmentioning

confidence: 99%

Anti-Protective Antigen IgG Enzyme-Linked Immunosorbent Assay for Diagnosis of Cutaneous Anthrax in India

Ghosh

Goel

2012

Clin. Vaccine Immunol.

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ABSTRACTAnthrax caused byBacillus anthracisis a public health problem in several developing countries whose main source of income is farming. Anthrax is a disease of herbivorous animals, and humans can be infected by handling infected animals or contaminated animal products. Specific diagnostic tests are unavailable in India for the detection and confirmation of cutaneous anthrax in humans. Here, we describe the development of an enzyme-linked immunosorbent assay (ELISA) for detection of serum antibodies againstBacillus anthracisprotective antigen in the Indian population. A total of 405 serum samples collected from different groups were tested by the developed ELISA. The assay provided a specificity of 99.41% (95% confidence interval [CI], 97.89 to 99.93) and a sensitivity of 100% (CI, 94.4 to 100) using a cutoff value of 0.29 ELISA unit (EU). The positive predictive value (PPV) and negative predictive value (NPV) of the assay were 97% and 100%, respectively. The efficiency and J index for the reliability of the assay were 99.5% and 0.994, respectively. The assay can be a very useful tool for surveillance as well as for diagnosis of cutaneous anthrax cases in India.

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Section: Discussionmentioning

confidence: 99%

Anti-Protective Antigen IgG Enzyme-Linked Immunosorbent Assay for Diagnosis of Cutaneous Anthrax in India

Ghosh

Goel

2012

Clin. Vaccine Immunol.

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“…34,35 However, gram stain and culture for B. anthracis can be unrevealing for patients who receive antibiotic therapy before specimens are obtained. 36,37 Historically, skin biopsies of cutaneous anthrax lesions have seldom been performed, and the histopathological features have been described in only a few untreated human cases and in experimental animals. 38 -41 In this report, we describe the histopathological features and the immunohistochemical (IHC) findings of bioterrorism-related cutaneous anthrax cases of 2001, and compare the results of IHC assays with other laboratory diagnostic methods, including culture, special stains, polymerase chain reaction (PCR), and serology.…”

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confidence: 99%

The Critical Role of Pathology in the Investigation of Bioterrorism-Related Cutaneous Anthrax

Shieh

Guarner

Paddock

et al. 2003

The American Journal of Pathology

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Cutaneous anthrax is a rare zoonotic disease in the United States. The clinical diagnosis traditionally has been established by conventional microbiological methods, such as culture and gram staining. However, these methods often yield negative results when patients have received antibiotics. During the bioterrorism event of 2001, we applied two novel immunohistochemical assays that can detect Bacillus anthracis antigens in skin biopsy samples even after prolonged antibiotic treatment. These assays provided a highly sensitive and specific method for the diagnosis of cutaneous anthrax, and were critical in the early and rapid diagnosis of 8 of 11 cases of cutaneous anthrax during the outbreak investigation. Skin biopsies were obtained from 10 of these 11 cases, and histopathological findings included various degrees of ulceration, hemorrhage, edema, coagulative necrosis, perivascular inflammation, and vasculitis. Serology was also an important investigation tool, but the results required several weeks because of the need to test paired serum specimens. Other tests, including culture, special stains, and polymerase chain reaction assay, were less valuable in the diagnosis and epidemiological investigation of these cutaneous anthrax cases. This report underscores the critical role of pathology in investigating potential bioterrorism events and in guiding epidemiological studies, Anthrax captured worldwide attention and aroused serious public health concerns following the intentional release of the etiological agent Bacillus anthracis in the United States postal system during Fall 2001, 1,2 resulting in 11 cases of inhalational anthrax and 11 cases of cutaneous anthrax. [3][4][5][6][7] In its conventional form, cutaneous anthrax accounts for 95% of all naturally occurring B. anthracis infections in the United States. 8 -11 Patients often have a history of occupational contact with animals or animal products contaminated with B. anthracis spores. 12-14 These pathogenic spores are introduced through a cutaneous cut or abrasion, with the most common areas of exposure are the head, neck, and extremities, although any area can be involved. Bacteremia and toxemia following cutaneous infection can occur with a fatality rate of 20% to 25% among untreated cases. [15][16][17] Cutaneous anthrax is characterized by the formation of a black eschar surrounded by prominent edema and vesicles, which may resemble many other skin lesions, such as the brown recluse spider bite, 18 -21 ulceroglandular tularemia, 22,23 plague, 24,25 ecthyma gangrenosum, 26,27 various spotted fever group rickettsial infections, 28 -31 and scrub typhus. 32,33 The clinical diagnosis of cutaneous anthrax is traditionally established by microbiological methods (eg, demonstrating gram-positive, capsulated bacilli on the smear of the lesion or isolating B. anthracis in culture). 34,35 However, gram stain and culture for B. anthracis can be unrevealing for patients who receive antibiotic therapy before specimens are obtained. 36,37 Historically, skin biopsies ...

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“…If a patient has a typical malignant pustule or malignant edema and has had a history of contact with animals, the diagnosis may be easy. The clinical laboratory diagnosis of cutaneous anthrax is generally established by conventional microbiological methods, such as bacterial cultures and directly gram staining smears of clinical specimens [15]. However, the clinical presentation could be atypical and the patient’s recollection of contact with animals may not be accurate, or the patient may neglect to supply this information.…”

Section: Discussionmentioning

confidence: 99%

Serum adenosine deaminase activity in cutaneous anthrax

et al. 2014

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BackgroundAdenosine deaminase (ADA) activity has been discovered in several inflammatory conditions; however, there are no data associated with cutaneous anthrax. The aim of this study was to investigate serum ADA activity in patients with cutaneous anthrax.Material/MethodsSixteen patients with cutaneous anthrax and 17 healthy controls were enrolled. We measured ADA activity; peripheral blood leukocyte, lymphocyte, neutrophil, and monocyte counts; erythrocyte sedimentation rate; and C reactive protein levels.ResultsSerum ADA activity was significantly higher in patients with cutaneous anthrax than in the controls (p<0.001). A positive correlation was observed between ADA activity and lymphocyte counts (r=0.589, p=0.021) in the patient group.ConclusionsThis study suggests that serum ADA could be used as a biochemical marker in cutaneous anthrax.

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Evaluation of the anthraxin skin test for diagnosis of acute and past human anthrax

Cited by 31 publications

References 3 publications

Anti-Protective Antigen IgG Enzyme-Linked Immunosorbent Assay for Diagnosis of Cutaneous Anthrax in India

Anti-Protective Antigen IgG Enzyme-Linked Immunosorbent Assay for Diagnosis of Cutaneous Anthrax in India

The Critical Role of Pathology in the Investigation of Bioterrorism-Related Cutaneous Anthrax

Serum adenosine deaminase activity in cutaneous anthrax

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