Cutaneous Anthrax, Belgian Traveler

A new tick-transmitted disease due to Rickettsia slovaca. Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease.tion of murine typhus and epidemic typhus using cross-adsorption and western blotting. Clin Diag Lab Immunol. 2000;7:612–6. 7. La Scola B, Raoult D. Laboratory diagnosis of rickettsioses: current approaches to the diagnosis of old and new rickettsial diseases. To the Editor: Anthrax is a rare zoonotic disease among travelers. The clinical spectrum includes cutaneous lesions, respiratory anthrax, pharyn-geal inflammation, gastrointestinal infection, septicemia, and meningitis. Interest in anthrax increased after the bioterrorist attacks in the United States in 2001. The following case history describes a cutaneous infection suspected to be anthrax in a tourist who had indirect contact with dead mammals in a disease-endemic area. After indirect contact with dead antelopes and a hippopotamus in Botswana, an acute necrotic lesion developed on a finger of a 31-year-old, healthy, female Belgian woman. The lesion became covered with a black crust, followed by massive swelling of the hand and arm. The clinical aspect and history strongly suggested cutaneous anthrax. This diagnosis was supported by serocon-version to protective antigen of Bacillus anthracis and the presence of antibodies against lethal factor. The bacterium itself could not be cultured or identified by polymerase chain reaction (PCR). Other members of the group with which she traveled were contacted, but no other cases were reported. small, painless, vesicular lesion developed on the dorsal side of her fourth left finger. This lesion increased in size quickly and developed a black aspect with a red elevated border. Small vesicles appeared in the immediate vicinity of the primary lesion. No pus was noted. Her general condition was good. She treated herself with amoxicillin-clavulanic acid 2 gm/day for 3 days. The next day, massive edema of the finger, hand, and left arm developed. When admitted to a hospital in Johannesburg, her left arm and hand were massively swollen with painful left axillary lym-phadenopathy. Her temperature never exceeded 37.8°C. Wound cultures showed only the presence of viridans streptococci, bacteria that are not implicated in wound infections. The patient was treated with intravenous ciprofloxacin, gentamicin, tetracy-cline, flucloxacillin, and topical mupirocin. She was discharged after 6 days with oral flucloxacillin and returned to Belgium on January 22. On February 4, her general condition was excellent; the edema had diminished. A painless necrotic lesion on the left fourth finger measured 3 cm 2 (Figure). She …