Injection anthrax causing compartment syndrome and necrotising fasciitis

Parcell, Benjamin J.; Wilmshurst, A.D.; France, Annick; Motta, Luisa; Brooks, Timothy; Olver, William J

doi:10.1136/jcp.2010.082586

Cited by 20 publications

(34 citation statements)

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“…Among other findings, analysis suggested associations between longer injecting histories, opioid substitution therapy, and alcohol use and risk for B. anthracis infection in persons who inject drugs (PWID) ( 6 ). Several case reports from the outbreak also have been published ( 8 – 12 ), but they did not include systematic examinations of the physical, laboratory, and surgical findings or of therapies administered. Notably, although 13 of the 47 persons from Scotland who had confirmed cases died, no published report has compared findings in survivors and nonsurvivors.…”

mentioning

confidence: 99%

ConfirmedBacillus anthracisInfection among Persons Who Inject Drugs, Scotland, 2009–2010

Booth¹,

Donaldson²,

Cui³

et al. 2014

Emerg. Infect. Dis.

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mentioning

confidence: 99%

ConfirmedBacillus anthracisInfection among Persons Who Inject Drugs, Scotland, 2009–2010

Booth¹,

Donaldson²,

Cui³

et al. 2014

Emerg. Infect. Dis.

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“…Una de ellas es el síndrome compartimental (4,5,10) , en el que se produce una elevación de la presión intersticial que sobrepasa a la presión de perfusión capilar en un compartimento cerrado; ello producirá isquemia de los tejidos muscular, nervioso y alteraciones del drenaje linfáti-co. Si este incremento de presión persiste, se produce necrosis de los tejidos, lo que puede conducir a la amputación e inclusive a la muerte. El diagnósti-co clínico reconoce signos y síntomas tempranos, como parestesias, dolor excesivo, flogosis, piel tensa y brillante, y signos tardíos, como el llenado capilar mayor a dos segundos, parálisis y ausencia de pulsos distales (11) .…”

Section: Discussionunclassified

“…La lesión cutánea es generalmente localizada y evoluciona desde una vesí-cula ulcerada de bordes inflamatorios hacia una úlcera necrótica indolora, acompañada de un edema de gradación variable (1) . Sin embargo, una infección bacteriana secundaria podría complicar el cuadro clínico (2,3) , pudiendo presentarse asociados un síndrome compartimental (4,5) o una fascitis necrotizante (FN) (5) , ambas complicaciones infrecuentes en esta patología.…”

Section: Introductionunclassified

Ántrax cutáneo complicado con fascitis necrotizante y síndrome compartimental

et al. 2013

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El ántrax o carbunco cutáneo es una zoonosis producida por el Bacillus anthracis, caracterizado por una úlcera necrótica, indolora, que cura generalmente espontáneamente y sin complicaciones. Presentamos el caso de un paciente varón agroganadero que presentó una úlcera necrótica rodeada de lesiones ampollares serohemáticas en cara ventral del antebrazo derecho y múltiples vesículas satélites purulentas, asociada a un edema extenso y dolor incapacitante del miembro afectado. Al ingreso, los exámenes revelaron leucocitosis (15 000/mL), CPK total (1 730 U/L) y prueba positiva de reacción en cadena de polimerasa (PCR) para Bacillus anthracis. Se diagnosticó síndrome compartimental y se realizó fasciotomía de emergencia. El reporte quirúrgico fue fascitis necrotizante, por finger test. En el seguimiento se evidenció contractura isquémica de Volkmann leve. Se debe plantear como diagnóstico el síndrome compartimental ante el dolor incapacitante, porque nos permitirá una intervención quirúrgica oportuna a fin de evitar perder la extremidad comprometida.

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“…In light of the recent injectional anthrax outbreak in heroin users (2,23,26), where deep tissue edema was a prominent effect, it is possible that anti-EF and anti-PA antibodies might have therapeutic value.…”

Section: Discussionmentioning

confidence: 99%

Mouse Monoclonal Antibodies to Anthrax Edema Factor Protect against Infection

et al. 2011

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Bacillus anthracis is the causative agent of anthrax, and the tripartite anthrax toxin is an essential element of its pathogenesis. Edema factor (EF), a potent adenylyl cyclase, is one of the toxin components. In this work, anti-EF monoclonal antibodies (MAb) were produced following immunization of mice, and four of the antibodies were fully characterized. MAb 3F2 has an affinity of 388 pM, was most effective for EF detection, and appears to be the first antibody reported to neutralize EF by binding to the catalytic C B domain. MAb 7F10 shows potent neutralization of edema toxin activity in vitro and in vivo; it targets the N-terminal protective antigen binding domain. The four MAb react with three different domains of edema factor, and all were able to detect purified edema factor in Western blot analysis. None of the four MAb cross-reacted with the lethal factor toxin component. Three of the four MAb protected mice in both a systemic edema toxin challenge model and a subcutaneous spore-induced foreleg edema model. A combination of three of the MAb also significantly delayed the time to death in a third subcutaneous spore challenge model. This appears to be the first direct evidence that monoclonal antibody-mediated neutralization of EF alone is sufficient to delay anthrax disease progression.

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Injection anthrax causing compartment syndrome and necrotising fasciitis

Cited by 20 publications

References 1 publication

ConfirmedBacillus anthracisInfection among Persons Who Inject Drugs, Scotland, 2009–2010

ConfirmedBacillus anthracisInfection among Persons Who Inject Drugs, Scotland, 2009–2010

Ántrax cutáneo complicado con fascitis necrotizante y síndrome compartimental

Mouse Monoclonal Antibodies to Anthrax Edema Factor Protect against Infection

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