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4. Skin diseases
Cutaneous anthrax
– A toxic in fection of herbivores d ue to Bacillus anthracis that is tran sm itted to hum an s
by in oculation through the sk in (con tact w ith in fected d ead an im als, flies). C utan eous
an thrax is com m on in the trop ics.
– P ulm on ary (tran sm itted by in halation ) an d in testin al (tran sm itted by eatin g in fected
m eat) form s also exist.
Clinical features 4
– P ap ule, then p ruritic vesicle that ulcerates an d becom es a black eschar surroun d ed by
sign ifican t oed em a w ith lym p h an gitis, region al ad en op ath y an d / or gen eralised
sign s. C utan eous an thrax usually occurs on un covered areas of the bod y (head , n eck ,
lim bs) an d is p ain less.
– I f n ot treated p rom p tly, th ere is a risk of exten sive, m align an t oed em a an d
sep ticaem ia.
Treatment
– Simple cutaneous anthrax (at d isp en sary level):
•A n tibiotic treatm en t:
phenoxymethylpenicillin (penicillin V) P O
C hild ren un d er 1 year: 2 5 0 m g/ d ay in 4 d ivid ed d oses for 7 to 1 0 d ays
C hild ren from 1 to 5 years: 5 0 0 m g/ d ay in 4 d ivid ed d oses for 7 to 1 0 d ays
C hild ren from 6 to 1 2 years: 1 g/ d ay in 4 d ivid ed d oses for 7 to 1 0 d ays
A d ults: 2 g/ d ay in 4 d ivid ed d oses for 7 to 1 0 d ays
F or p atien ts allergic to p en icillin :
doxycycline P O (excep t for child ren un d er 8 years an d p regn an t or lactatin g w om en )
C hild ren over 8 years an d ad ults: 2 0 0 m g/ d ay in 2 d ivid ed d oses for 7 to 1 0 d ays
or
erythromycin P O
C hild ren : 3 0 to 5 0 m g/ k g/ d ay in 2 or 3 d ivid ed d oses for 7 to 1 0 d ays
A d ults: 2 to 3 g/ d ay in 2 or 3 d ivid ed d oses for 7 to 1 0 d ays
•D o n ot excise the eschar. D aily d ry d ressin gs.
– Cutaneous anthrax with extensive oedema or generalised signs or cutaneous
anthrax localised on the head or neck (at hosp ital level):
benzylpenicillin procaine + benzylpenicillin or benzylpenicillin procaine I M
C hild ren : 1 0 0 0 0 0 IU / k g/ d ay in 1 or 2 in jection s
A d ults: 4 M IU / d ay in 1 or 2 in jection s
109
Cutaneous anthrax
– A toxic in fection of herbivores d ue to Bacillus anthracis that is tran sm itted to hum an s
by in oculation through the sk in (con tact w ith in fected d ead an im als, flies). C utan eous
an thrax is com m on in the trop ics.
– P ulm on ary (tran sm itted by in halation ) an d in testin al (tran sm itted by eatin g in fected
m eat) form s also exist.
Clinical features 4
– P ap ule, then p ruritic vesicle that ulcerates an d becom es a black eschar surroun d ed by
sign ifican t oed em a w ith lym p h an gitis, region al ad en op ath y an d / or gen eralised
sign s. C utan eous an thrax usually occurs on un covered areas of the bod y (head , n eck ,
lim bs) an d is p ain less.
– I f n ot treated p rom p tly, th ere is a risk of exten sive, m align an t oed em a an d
sep ticaem ia.
Treatment
– Simple cutaneous anthrax (at d isp en sary level):
•A n tibiotic treatm en t:
phenoxymethylpenicillin (penicillin V) P O
C hild ren un d er 1 year: 2 5 0 m g/ d ay in 4 d ivid ed d oses for 7 to 1 0 d ays
C hild ren from 1 to 5 years: 5 0 0 m g/ d ay in 4 d ivid ed d oses for 7 to 1 0 d ays
C hild ren from 6 to 1 2 years: 1 g/ d ay in 4 d ivid ed d oses for 7 to 1 0 d ays
A d ults: 2 g/ d ay in 4 d ivid ed d oses for 7 to 1 0 d ays
F or p atien ts allergic to p en icillin :
doxycycline P O (excep t for child ren un d er 8 years an d p regn an t or lactatin g w om en )
C hild ren over 8 years an d ad ults: 2 0 0 m g/ d ay in 2 d ivid ed d oses for 7 to 1 0 d ays
or
erythromycin P O
C hild ren : 3 0 to 5 0 m g/ k g/ d ay in 2 or 3 d ivid ed d oses for 7 to 1 0 d ays
A d ults: 2 to 3 g/ d ay in 2 or 3 d ivid ed d oses for 7 to 1 0 d ays
•D o n ot excise the eschar. D aily d ry d ressin gs.
– Cutaneous anthrax with extensive oedema or generalised signs or cutaneous
anthrax localised on the head or neck (at hosp ital level):
benzylpenicillin procaine + benzylpenicillin or benzylpenicillin procaine I M
C hild ren : 1 0 0 0 0 0 IU / k g/ d ay in 1 or 2 in jection s
A d ults: 4 M IU / d ay in 1 or 2 in jection s
109
