Anthrax carbuncle( or pustula maligna) is a painless specific manifestation on the skin in the form of a necrotic inflammation focus in case of anthrax. Pathology occurs at the site of penetration of the pathogen.
Anthrax( anthrax) is an acute zoonotic infection transmitted from animals that occurs with severe intoxication, acute inflammation with hemorrhages of the lymph nodes, skin and internal organs, often resulting in death. In people in 98 - 99% of cases, the disease is expressed in carbuncle form, accompanied by the formation of subcutaneous carbuncle. About how the anthrax is transmitted to a person, about her symptoms, treatment and prevention, we will be able to talk today.
Features of the disease in humans
In humans, anthrax is more common in carbuncle form - that is, with the development of carbuncle in anthrax. In the case of its formation on the head, neck, mucous larynx and pharynx, the disease is difficult and threatens the transition to septicemia, as swelling quickly seizes the tissues of the respiratory tract, leading to suffocation and death of the patient.
In most case histories a single lesion is formed, but in 10 - 13% of cases develops up to 10 - 20 skin pathologies. Bacteria that lead to the appearance of cutaneous pathology - spore forming bacteria - Bacillus anthracis.
Externally and for development, the anthrax species of carbuncle differs from typical purulent forms with the following features:
- the formation of a central hearth with an unviable tissue and a coal-black scab at the place of the bursting purple-blue bubble;
- formation of "child" vesicles around an ulcer in the form of a "necklace";
- sensation of numbness and loss of pain sensitivity in the carbuncle zone;
- lack of purulent contents.
More details about the features of anthrax will tell this video:
The pathological manifestations occurring when anthrax rods are inserted under the skin, - the development of carbuncle, edema and dry necrosis with the breakdown of proteins, are caused by exposure to exotoxin - the poison that secretes Bacillus anthracis.
Progression stages of
Changes in the development of pustula maligna undergo specific stages:
- A painless cherry-blue macula( diameter) of about 1 to 3 mm in diameter appears on the skin of the bacillus, which is often mistaken for an insect bite.
- After 3 - 6 hours on the spot spot there is a convex papula( densification), slightly raised above the skin, starting to itch.
- Within 12 - 36 hours the papule becomes a vesicle - a blue-purple bubble about 3 mm with a turbid exudate, which gradually becomes dark during the filling with a bloody liquid. In this case, the patient is severely affected by increasing itching.
- The vesicle is opened for 3 to 4 hours( alone or with combs), and an ulcer with a dark brown bottom and walls covered with serous hemorrhagic exudate( a liquid with blood cells seeping through the walls of the capillaries) appears on this site.
- During the following days, the "child" vesicles appear along the perimeter of the wound, merging with each other and increasing the area of ulceration to 10-20 mm.
- In the middle of the ulcer, at first a scab is formed - dark purple and painless, then, due to cell death, it thickens, hardens, acquiring coal-black color, and around it forms hyperemic inflammation. The edema around the carbuncle in areas with loose fiber( face, neck) often captures a vast area.
- Externally, the scab is very much like a black glowing coal, which gave rise to the definition of anthrax in medical terminology, as anthrax, which in Greek means "coal."
- Around the ulcers, a soft swelling of the tissues grows, which become pale blue, swell, reminiscent of a jelly-like mass.
The process of development of pustula maligna with cutaneous form of anthrax takes place in three different forms:
- With carbuncle-shaped , the pathology of the carbuncle appears and passes through all typical stages from spot to black scab.
- The edematous variety differs in that the primary edema at the first stages increases without skin inflammation and visible development of vesicles. But later on the swollen site there is cell death( necrosis) and a large carbuncle is formed.
- For the bullous variety , the introduction of the bacillus is characterized by the appearance of multiple blisters with bloody exudate. At the site of their dissection, there are extensive necrotic ulcers with a black scab in the center.
- The erisipeloid appearance of the pathology is manifested by the development of a variety of vesicles with serous fluid that burst, leaving ulcers with a dark focus of necrosis.
Causes of the occurrence of
Carbuncle occurs and develops due to the penetration of the human Bacillus anthracis and anthrax in dermal form. Pathogenic bacteria showed high resistance to aggression of the environment - it easily survives at extreme temperatures( up to 130 C), solar irradiation, drying, disinfection treatment.
A person is more often infected with an anthrax bacillus through injuries and minor injuries on the skin and mucous membranes in contact with living and dead animals, dressing skins, using meat, and also when the pathogen gets from water and soil abundantly contaminated with spores of bacteria.
On what the first symptoms of the disease are anthrax, we will tell below.
Signs of anthrax in humans
The latent stage after the introduction of the pathogen can last from 5 to 8 hours to 2 weeks, but more often it lasts 2 to 3 days. For a person, the most typical appearance of a carbuncle type, in which the skin areas are not affected by clothing.
Local specific symptoms of
The following pathological changes occur at the site of introduction of the bacilli:
- the gradual formation of the carbuncle from the spot to the dark crimson vesicle bursting with the formation of the
- ulcer in the area of infection accompanied by burning;
- rapid formation of dry black necrosis in the center of an ulcer surrounded by bright red inflammation and swelling;
- absence of suppuration and pain when pressing on the scab;
- sensation of numbness in the necrosis zone;
- is an inflammation of the lymph nodes, also passing without pain and suppuration.
Common Symptoms of
About 8 people out of 10, the carbuncletic form of anthrax flows easily or causes moderate to severe reactions. The following symptoms are noted:
- moderately severe poison syndrome with anthrax;
- body temperature remains normal or increases to subfebrile( 38 C);
- on the 14th-20th day, the necrotic scab is rejected with or without the formation of an ulcer, which is quickly filled with a granulation( young connective) tissue;
- ulcer is tightened by scarring.
The mild course of the disease and the development of the carbuncle is completed by the patient's recovery.
In case of moderate and severe anthrax in carbuncle form,
- is marked weakness, malaise, nausea, headaches, vomiting;
- temperature rise within 2 days after the appearance of the first signs to 40 ° C, chills;
- dysfunction of the heart and blood vessels.
With favorable development by the 7th day of the disease, the temperature rapidly decreases, general and local symptoms of intoxication become less pronounced, edema decreases, signs of inflammation of the lymph nodes disappear, and the scab is rejected on days 14-28.Sometimes this process is delayed up to 2 months.
Diagnosis of anthrax carbuncle is made:
- Based on the analysis of local manifestations on the skin, which include:
- appearance of the carbuncle;
- stages of development from the spot to the scab;
- presence of itching and burning at the vesicle stage;
- formation of dry coal-black necrotic scab;
- loss of sensitivity in the area of carbuncle, pain and suppuration
- Specific symptoms in the examination:
- is a symptom of Stefansky, in which the percussion hammer blowing in the area of the edema around the carbuncle often causes a small "swell" of tissues resembling jelly trembling. In the zone of dry necrosis of anthrax carbuncle, the pain does not appear even under severe stimulation( when the needle is pricked), which is a serious sign when diagnosing and differentiating carbuncle in anthrax from other types of skin suppuration.
- inflammation of the lymph nodes that develops in the cutaneous form of the pathology also passes without pain and pus formation
- Based on the results of laboratory tests taking into account the epidemiological situation in the region.
Laboratory diagnostics includes the application of:
- bacterioscopy with culture on nutrient media and isolation of anthrax bacillus;
- immunofluorescent method for early diagnosis;
- skin-allergic test with anthraxin( hydrolyzate Bacillus anthracis), which shows a positive result, starting with the fifth day of infection with anthrax.
In carbuncle disease, the material for examination is the internal contents of the vesicle and carbuncle, ulcerous discharge, exudate under the scab, as well as blood, feces, vomit and sputum.
The treatment and symptoms of anthrax will tell this video:
Therapist Therapeutic and medical methods
Treatment of anthrax carbuncle as a symptom and local inflammation on the skin is performed exclusively in a hospital with etiotropic therapy aimed at eliminating the cause of the disease -destruction of anthrax bacillus.
Provision is made for:
- Specific anti-STI immunoglobulin, which is administered intramuscularly at a dose of 20 ml or 40 - 80 ml( for mild and moderate and severe form, respectively).It is used only after the desensitization procedure, aimed at reducing the body's sensitivity to globulin. Dosage for the entire course is approximately 400 ml.
- Antibacterial agents.
- The most commonly used benzylpenicillin, the daily dosage of which is calculated based on the norm of 200 000 - 300 000 units per kilogram of the patient's weight, and is divided into 8 - that is, the antibiotic is injected every 3 hours.
- Oxacillin( daily dose up to 8 g), ampicillin( up to 4 - 6 g per day) is also used.
- With severe allergies to the penicillin series of antibiotics, Ciprofloxacin, Erythromycin, Chloramphenicol, Morphocycline( 0.3 to 0.5 grams intramuscularly at 6 hours), Oleandomycine( macrolide group), are administered inside the vein or muscle in a daily dose of up to 2 grams. Typically, the choice of dosage and combination of antibiotics is determined by the doctor in the analysis of the severity of the disease. But the treatment continues in any case for at least 8 to 10 days until an obvious positive result is achieved: removal of the edema around the carbuncle and inflammation of the lymph nodes, stopping the growth of the carbuncle resulting from the ulceration of the "daughter" vesicles, stabilization of the normal temperature.
- In severe cases, use cephalosporins( up to 4 - 6 grams per day), Levomycetin( 3 - 6 grams per day), Gentamicin( 240 - 320 mg per day).Observations prove that active bacilli die in carbuncle tissues within 5 hours after the initiation of antibacterial therapy with penicillins. Under the influence of antibiotics, the development of carbuncle occurs with positive changes - swelling rapidly decreases, general intoxication decreases due to mass death of anthrax bacillus, but antibiotic preparations do not affect the process of rejection of the scab.
- Application simultaneously with antibiotics antipyretic and anti-inflammatory drugs( Ketonal, Texamen, Dexalgin).
- Carrying out procedures for irradiating the carbuncle area with a quartz lamp for the purpose of additional disinfection, acceleration of the prolongation of the ulcer, and removal of the edema.
- Local treatment
The question of the need for local treatment in the carbunculatory form of the disease is not solved in medicine unambiguously. According to some experts, carbuncle with anthrax does not require local treatment. Others adhere to the following therapies:
- carbuncle is washed with antiseptic liquids with a dry sterile dressing applied, which must be destroyed after use.
- with uncomplicated development of carbuncle, depth penetration of tissues of its basement zone and adjacent to the solution of novocaine 0.25-0.5% in a volume of 10 ml with penicillin and streptomycin( 100,000 units of each agent).
In the opinion of some specialists, surgical intervention with an anthrax carbuncle is inexpedient and can lead to the spread of infection and the probability of infection of the blood( sepsis).
An alternative view takes into account the need for operation in neglected cases. Use local anesthesia and conduct an incision( linear or cruciform, if the carbuncle is large).Non-viable tissues are completely excised, filling the wound with tampons impregnated with NaCl or ointments-penicillin, sintomycin, sulfamide.
Prevention of the disease
Carbuncle form of anthrax requires mandatory preventive measures, which include:
- General measures to prevent the infection of agricultural animals with which a person is in contact. These measures are carried out with the constant monitoring of epidemics among animals by veterinary services.
- Active observation for 2 to 3 weeks for adults and children who have been in contact with infectious animals or used to eat meat.
- Conducting in the potential foci of the possible occurrence of an epidemic of anthrax of the annual vaccination of both humans and animals with dry vaccine STI.
- Introduction to adults, adolescents from 14 years and children of a specific immunoglobulin at a dosage of 20, 10, 5 ml, respectively.
- Immediate hospitalization of a person in case of suspected infection with his anthrax in a separate room with the allocation of individual( more often - disposable) care items, linen, dishes.
- Daily disinfection of the room using a solution of mercuric chloride in a ratio of 1 to 500 in combination with 3% phenol. All dressings are burned after use.
- The discharge from the hospital of patients with carbuncle form of anthrax only after rejection of the scab, healing and scarring of ulcers.
In case of occurrence and progression of pustula maligna it is possible:
- development of carbuncles on the mucous membrane of the respiratory tract, esophagus followed by perforation( through violation of the walls) and massive bleeding;
- development of secondary sepsis that occurs when anthrax bacillus enters the blood and spreads infection throughout the body.
- is a severe course of pathology, especially if the carbuncle forms in the head, neck and upper respiratory tract, where asphyxia is likely due to progressive edema and septicemia with an unfavorable outcome.
For human anthrax in carbuncle-shaped form, the prognosis is favorable in most cases, but in the absence of treatment for anthrax carbuncle, the death rate is 10-20%.
More information about the anthrax carbuncle is contained in the video of Elena Malysheva: