THE COMPARISON OF PROPOLIS EFFECTS ON TUMOR NECROSIS FACTOR ALPHA AND MALONDIALDEHYDE BETWEEN INHALATION AND CUTANEOUS ANTHRAX ANIMAL MODELS

Background: Inflammatory response and oxidative stress can be found in anthrax characterized by increased level of serum Tumor Necrosis Factor Alpha (TNF-α) and Malondialdehyde (MDA). The use of antibiotics in anthrax has been known to cause some disturbing side-effects, such as allergic reaction, nausea, vomiting, and antibiotic resistance. Thus, ethanolic extract of propolis (EEP) might be the alternative regimen, due to its anti-inflammatory and antioxidant properties. This study aimed to compare the effects of ethanolic extract of propolis (EEP) on TNF-α and MDA between the inhalation and cutaneous anthrax animal model. Materials and Methods: This was an experimental study with a post-test-only control group design on 40 samples of Rattus norvegicus. Samples were randomized into 5 groups: control, inhalation anthrax model, inhalation anthrax model + EEP, cutaneous anthrax model, and cutaneous anthrax model + EEP. After 14 days, the level of TNF-α and MDA were measured. To compare the data, we used the ANOVA test continued by the post-hoc Turkey test. Results: The results obtained showed that the level of TNF-α and MDA between the inhalation and cutaneous anthrax animal models treated with EEP were statistically different (p < 0.05). The P5 group showed the lowest level of TNF-α (6.822 ± 0.383 pg/ml) and MDA (2.717 ± 0.383 nmol/ml). Conclusion: EEP has a better effect on reducing TNF-α and MDA in cutaneous anthrax animal models compared to the inhalation anthrax animal model.

Treatment of venous ulcers in drug addicts: A case report

Venous ulcers are common in drug addicts and, although the management of these wounds is the same as in other patients, there are differences in the approach and the outcome of treatment. Those injecting drugs are at risk of serious infections, such as necrotizing fasciitis, wound botulism, and cutaneous anthrax due to the nature of the substances being injected. Herein, we present two cases of venous ulcers in drug addicts in their thirties. Both patients had been suffering from a venous ulcer for several years and the final result differed in the two patients. We concluded that it is necessary to raise awareness of the importance of treatment and lifestyle changes. The multidisciplinary approach in these patients may contribute to the improvement of wound healing.

Cutaneous Anthrax on the Upper Eyelid

A 46-year-old female patient, who presented with a black, crusty lesion on the upper eyelid, was diagnosed with cutaneous anthrax after the detection of <i>Bacillus anthracis</i> in the skin culture. It was determined that the symptoms started after she cooked the meat she bought from a butcher. Anthrax is a disease that should be kept in mind in cutaneous infections even in isolated lesions, especially in endemic areas.

Cutaneous anthrax associated with handling carcasses of animals that died suddenly of unknown cause: Arua District, Uganda, January 2015–August 2017

Background Anthrax is a zoonotic disease that can be transmitted to humans from infected animals. During May–June 2017, three persons with probable cutaneous anthrax were reported in Arua District, Uganda; one died. All had recently handled carcasses of livestock that died suddenly and a skin lesion from a deceased person tested positive by PCR for Bacillus anthracis. During July, a bull in the same community died suddenly and the blood sample tested positive by PCR for Bacillus anthracis. The aim of this investigation was to establish the scope of the problem, identify exposures associated with illness, and recommend evidence-based control measures. Methods A probable case was defined as acute onset of a papulo-vesicular skin lesion subsequently forming an eschar in a resident of Arua District during January 2015–August 2017. A confirmed case was a probable case with a skin sample testing positive by polymerase chain reaction (PCR) for B. anthracis. Cases were identified by medical record review and active community search. In a case-control study, exposures between case-patients and frequency- and village-matched asymptomatic controls were compared. Key animal health staff were interviewed to learn about livestock deaths. Results There were 68 case-patients (67 probable, 1 confirmed), and 2 deaths identified. Cases occurred throughout the three-year period, peaking during dry seasons. All cases occurred following sudden livestock deaths in the villages. Case-patients came from two neighboring sub-counties: Rigbo (attack rate (AR) = 21.9/10,000 population) and Rhino Camp (AR = 1.9/10,000). Males (AR = 24.9/10,000) were more affected than females (AR = 0.7/10,000). Persons aged 30–39 years (AR = 40.1/10,000 population) were most affected. Among all cases and 136 controls, skinning (ORM-H = 5.0, 95%CI: 2.3–11), butchering (ORM-H = 22, 95%CI: 5.5–89), and carrying the carcass of livestock that died suddenly (ORM-H = 6.9, 95%CI: 3.0–16) were associated with illness. Conclusions Exposure to carcasses of animals that died suddenly was a likely risk factor for cutaneous anthrax in Arua District during 2015–2017. The recommendations are investigation of anthrax burden in livestock, prevention of animal infections through vaccinations, safe disposal of the carcasses, public education on risk factors for infection and prompt treatment of illness following exposure to animals that died suddenly.

A Case Report of Cutaneous Anthrax from North Eastern Iran

In this study, we evaluated the clinical findings, therapy, and outcomes in a patient with cutaneous anthrax who was co-infected with HSV 1&2 (Herpes Systemic Virus) and S. Pyogenes (Streptococcuspyogenes) at the time of hospitalization.

Human Anthrax in Dolj County, Romania—A Series of Three Cases

Bacillus anthracis is the causative agent of anthrax, primarily a disease of herbivorous animals, which can be accidentally transmitted to humans. Three cases of cutaneous human anthrax were recorded in August 2020 in Dolj county, Romania. These cases included livestock farmers (husband and wife, as well as a man from their entourage). The women presented malignant edema, which required surgery for compartment syndrome; and the men presented the common form of cutaneous anthrax. According to the laboratory investigation, two cases complied with the criteria in the case definition. All cases were successfully treated with antibiotics and the women received reconstructive plastic surgery of the skin defects, restoring normal hand function. The contact with sick animals was ruled out by the health authorities concluding that it was the contamination of pre-existing skin lesions with B. anthracis spores from the soil, the anthracogenic area.

Cutaneous anthrax outbreak associated with handling dead animals, Rhino Camp sub-county: Arua District, Uganda, January–May 2018

Background On 18 January 2018 a 40 year old man presented with skin lesions at Rhino Camp Health Centre. A skin lesion swab was collected on 20 January 2018 and was confirmed by PCR at Uganda Virus Research Institute on 21 January 2018. Subsequently, about 9 persons were reported to have fallen ill after reporting contact with livestock that died suddenly. On 9 February 2018, Arua District notified Uganda Ministry of Health of a confirmed anthrax outbreak among humans in Rhino Camp sub-county. We investigated to determine the scope and mode of transmission and exposures associated with identified anthrax to guide control and prevention measures. Methods We defined a suspected cutaneous anthrax case as onset of skin lesions (e.g., papule, vesicle, or eschar) in a person residing in Rhino Camp sub-county, Arua District from 25 December 2017 to 31 May 2018. A confirmed case was a suspected case with PCR-positivity for Bacillus anthracis from a clinical sample. We identified cases by reviewing medical records at Rhino Camp Health Centre. We also conducted additional case searches in the affected community with support from Community Health Workers. In a retrospective cohort study, we interviewed all members of households in which at least one person had contact with the carcasses of or meat from animals suspected to have died of anthrax. We collected and tested hides of implicated animals using an anthrax rapid diagnostic test. Results We identified 14 case-patients (1 confirmed, 13 suspected); none died. Only males were affected (affected proportion: 12/10,000). Mean age of case-persons was 33 years (SD: 22). The outbreak lasted for 5 months, from January 2018–May 2018, peaking in February. Skinning (risk ratio = 2.7, 95% CI = 1.1–6.7), dissecting (RR = 3.0, 95% CI = 1.2–7.6), and carrying dead animals (RR = 2.7, 95% CI = 1.1–6.7) were associated with increased risk of illness, as were carrying dissected parts of animals (RR = 2.9, 95% CI 1.3–6.5) and preparing and cooking the meat (RR = 2.3, 95% CI 0.9–5.9). We found evidence of animal remains on pastureland. Conclusion Multiple exposures to the hides and meat of animals that died suddenly were associated with this cutaneous anthrax outbreak in Arua District. We recommended public education about safe disposal of carcasses of livestock that die suddenly.

Cutaneous Anthrax: Evaluation of 27 Cases

Introduction: While the incidence of anthrax is decreasing in Turkey, it is still endemic in some regions of the country. In this study, it was aimed to develop preventive methods by determining the characteristics of cutaneous anthrax after assessing the literature over the last six years (2013-2019) of cutaneous anthrax cases in Turkey. Materials and Methods: The studies carried out in the last six years on cutaneous anthrax were examined retrospectively. Diagnosis, physical examinations, vital signs, laboratory results, medical treatments of the evaluated cases were performed and tables on demographic characteristics were developed. Results: Patients' age ranged from 8 to 65 years. A total of 13 patients (48.1%) who were assessed were males. The source of infection was contact with infected animal and its products in 23 cases (85.2%), husbandry in 2 cases (7.4%), contact with infected blood in one case (3.7%), and being in the same environment with an anthrax diagnosed patient in one case (3.7%). As a result of microbiological investigations, it was found out that 10 patients (37%) had Bacillus anthracis. All patients received penicillin treatment. Only three patients were surgically treated. Treatment resulted in recovery in 26 cases. Conclusion: In order to prevent the disease, preventive measures such as training of risky individuals dealing with animal husbandry and vaccination of animals will reduce the incidence of the disease.

Gambaran Umum, Prevalensi, dan Pencegahan Antraks pada Manusia di Indonesia

Anthrax is a neglected zoonotic disease that remains a global issue because it can cause regular epidemics. Anthrax affects not only health systems but also social-economic conditions, safety, and welfare of the people. This paper aimed to give an overview of human anthrax, prevalence, and prevention in Indonesia. A literature search was performed using search engines such as Google Scholar, Crossref, Mendeley, PLoS One, Elsevier, dan the Ministry of Health official website. The literature used were published between 2015-2020. Anthrax is caused by Bacillus anthracis that affects animals and humans. The virulence factors of these bacteria are determined by the tripartite toxin complex and poly-γ-D-glutamic acid capsule. Anthrax in humans can be found in four forms, namely cutaneous, gastrointestinal, inhalational, and injection anthrax. Each form of anthrax can develop into meningitis and sepsis. Anthrax treatment is commonly done by administering antibiotics. In Indonesia, 14 provinces have been declared anthrax endemic areas. The prevalence of human anthrax in Indonesia is fluctuating and most of it is cutaneous anthrax. Prevention and control of anthrax can be done mainly by vaccination, obeying the rules or standard operating procedures of the authorities, multisectoral cooperation, strengthening anthrax surveillance, increasing resources for diagnosis, increasing public knowledge, and awareness.