Published Date: 2014-08-28 19:26:27
From: Osthoff Michael Friedrich <Michael.Osthoff@usb.ch> [edited]
We report an imported case of cutaneous anthrax. A 61-year-old lady of Turkish origin consulted us in early August  after having just returned [to Switzerland] from Turkey. She had visited friends and relatives in the Haymana district of Ankara [province] for the past 6 weeks. In the last week of her stay, cattle, which were just coming back from grazing in the neighbourhood, suddenly started to die. The carcasses were butchered, and the meat was consumed by many people in the town. Our patient was involved in butchering the carcasses as well as consuming the meat.
After arrival at the airport in Basel [Switzerland], she was notified by her relatives that at least 20 neighbours and family members had just been admitted to a local hospital with fever, skin ulcers and vomiting. She denied any constitutional symptoms, vomiting, diarrhoea, shortness of breath or coughing. On examination, a small, painless ulcer with a central black eschar and raised borders on her right index finger was noted. No other skin or oral lesions were present, and she was afebrile. She did not remember any injuries.
A swab was taken from beneath the eschar for culture [perfect!], and the patient was started on ciprofloxacin 2x500mg for suspected cutaneous anthrax. The culture grew Gram-positive bacilli after 24 hours, which were presumptively identified as _Bacillus anthracis_ by MALDI-TOF mass spectrometry on the same day and subsequently confirmed by PCR (amplification of gyr, pag, cap) at the Swiss National Reference Laboratory for Anthrax.
After 5 days of treatment, the wound had almost completely healed at the next consultation.
Anthrax is a notifiable disease in Switzerland. This is the 1st human case of anthrax in Switzerland since 1991. Although very rare, it is important to consider cutaneous anthrax as a differential diagnosis in a returning traveller with skin ulcers.
Michael Osthoff, MD
Reno Frei, MD
University Hospital Basel
Divisions of Infectious Diseases and Hospital Epidemiology and Clinical Microbiology
Nadia Schurch, PhD
Stephen Leib, MD
National Reference Laboratory for Anthrax