Anthrax at the hospital: the tip of the iceberg.

One of the conclusions from this study is that 85% of the patients were hospitalized. According to the medical literature and to recent clinical studies conducted in the field most of the patients with cutaneous anthrax did not present with systemic manifestations, thus did not need to be hospitalized. Most of them were taken care of in the outpatient clinics. Another conclusion is that 100% of the patients presented with an ulcer with central necrosis. Cutaneous anthrax starts out with a papule, which grows into a vesicle, which becomes hemorrhagic and depressed. In the late stage, it becomes a necrotic ulcer with a central black eschar. The necrotic ulcer is the late stage of anthrax. Physicians are used to associating cutaneous anthrax only with the late stage of the necrotic ulcer, perhaps due to the name given by Hypocrates of “anthrax” or the Latin American term of “carbunco”, which basically refer to the late stage. Unfortunately, the conclusion of this study reinforces this concept. In contrast to what this urban study reflects, in anthrax-endemic areas in the country, farmers emphasized the early diagnosis of the ulcered vesicle with inflamed borders, yellowish bottom. They have identified it by popular names such as the “waytacha” (Fig. 1a). The easiness in early recognition is due to the frequency of the disease in these areas. Its is important to recognize the necrotic ulcer stage (Fig. 1b), however it is more useful to recognize the cutaneous lesion early because this will lead to decreased risk of disease dissemination.