Human Anthrax in Turkey from 1990 to 2007

Abstract

Anthrax is an endemic disease in Turkey, among other countries of the world. The potential of Bacillus anthracis as a bioterrorism agent makes anthrax an important global issue. The aim of the present study was to review human anthrax in Turkey during the last decade. Human anthrax cases recorded from 1990 to 2005 were obtained from the website of the Turkish Ministry of Health, and those recorded between 1995 and 2005 were plotted on a map of Turkey. Papers on anthrax published from Turkey between 1990 and 2007 were collected and reviewed. Most cases were recorded from the central and eastern parts of Turkey. Three of the reports appeared in international journals prior to 1990, 10 reports appeared in the 1990s, and 24 reports appeared after the anthrax events of 2001 in the United States of America. These reports included 926 cases, 426 of which could be reviewed: 413 (96.9%) cases of cutaneous anthrax, 8 (1.9%) cases of gastrointestinal anthrax, and 5 (1.2%) cases of anthrax meningitis. Of all the affected patients, 95.2% had contact with contaminated materials. All human origin isolates were sensitive to penicillin and did not produce beta-lactamase. Most of the patients (88.7%) had received penicillin G. Total mortality was 2.8%. Anthrax is an endemic disease in Turkey, and acquisition of infection is generally through contact with ill or dying animals or animal products. Sheep and cattle are generally involved. Most clinical disease in humans is cutaneous anthrax, although other clinical forms are seen and have a greater mortality. Penicillin remains the drug of choice in treating the disease. Controlling anthrax in humans depends on controlling the infection in animals.

Natural Exposure to Cutaneous Anthrax Gives Long-Lasting T Cell Immunity Encompassing Infection-Specific Epitopes

“…Through the National Institutes of Health-National Institute of Allergy and Infectious Diseases Immune Epitope Database, there has been an international initiative to map and characterize epitopes from a wide range of category A-C bacterial and viral pathogens of concern in the developing world and with respect to biowarfare threats (40). The current investigation benefited from being able to marry the resources and methodologies of the Immune Epitope Database to a valuable cohort of patients: individuals in the Kayseri region of rural Turkey who had been diagnosed with and recovered from cutaneous anthrax (41). Even several years after antibiotictreated anthrax infection, strong T cell immunity was detectable.…”

A Rare Clinical Presentation and Outcome of Cutaneous Anthrax: Toxemic Shock: Case Report

“…While cutaneous lesions are usually single, sometimes two or more lesions may be present. [1][2][3][7][8][9]11 In our case group, a single lesion was present in 18 patients and 2 lesions in 4 patients. Lesions were localized on the hands and the arms in 20 cases, on the neck in 1 case and on the face in 1 case.…”

“…The incidence of the disease in Turkey has been decreasing with economic and social changes, strict animal vaccination programs and education of farmers. 2,4 According to the report of the Turkish Ministery of Health, 320 human cases were notified in 2005 in Turkey. Almost all of the cases reported until today were cutaneous anthrax.…”

“…Other clinical forms of anthrax, such as sepsis, meningitis, throat anthrax and intestinal anthrax were also reported as few cases previously. 2,[8][9][10][11][12] Although anthrax occurs throughout the year in Turkey, the majority of cases occur in late summer and autumn, which are the driest and hottest seasons. 2,4 A well-developed anthrax lesion could be easily recognized by a physician familiar to the condition.…”

“…This clinical form is potentially life-threatening and a very rare complication of cutaneous anthrax. [1][2][3]7 Twenty-two cases with cutaneous anthrax were diagnosed and treated between 2002 and 2008. Only 2 cases were diagnosed with toxemic shock.…”