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Published Date: 2012-07-10 17:08:05
Subject: PRO/AH/EDR> Anthrax - Germany (07): (Berlin) early self treatment
Archive Number: 20120710.1196322

ANTHRAX, GERMANY (07): (BERLIN) EARLY SELF TREATMENT
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Date: Mon 9 Jul 2012
From: Dimitrios Frangoulidis <DimitriosFrangoulidis@Bundeswehr.org> [edited]

This 3rd and surviving patient [see: ProMED report: Anthrax - Germany (06): (Berlin) new case 20120705.1191168] is different to the 2 in Bavaria. It is not the new clinical entity of a severe tissue infection with septicemic signs.

The 3rd case was identified through an enlarged case definition: heroin/drug user and skin-lesion including eschar. The PCR for _Bacillus anthracis_ was positive but the patient had received antibiotic treatment before going to the hospital -- maybe this was a life-saving "feature" of the case.

Our colleagues in Berlin were also able to detect specific PA-antibodies in serum -- also a difference with the Bavarian cases and therefore also a hint of a more prolonged infection. This and the absence of systemic disease in combination with an early antibiotic treatment could make a strain isolation much more difficult.

They were certainly trying to identify any genomic variations specific for this cluster. This is not made easy by the small amount of isolated DNA. But we should remain optimistic.

--
Dr med Dimitrios Frangoulidis, LtCol, MC, MD
Bundeswehr Institute of Microbiology
Neuherbergstr. 11
80937 Munich
Germany
<DimitriosFrangoulidis@Bundeswehr.org>

[Clearly the news dissemination in Germany had prewarned this 3rd addict that he needed prompt treatment if he got ill after injecting himself. This is not uncommon with patients' cutaneous lesions and makes isolation of the pathogen difficult unless there are advanced DNA identification technologies at hand, and the funding to mobilise them.

On the other hand the recent mortal case in Denmark (see ProMED-mail posting 20120709.1195198) indicates that being HIV positive can stack the deck against one.

Our thanks to Dimitrios for this update on what had been a very puzzling case. - Mod.MHJ

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2HYi.]

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