Published Date: 2012-07-13 16:13:09
Subject: PRO/AH> Anthrax - Germany (08): (Berlin) ongoing investigations
Archive Number: 20120713.1200646
ANTHRAX - GERMANY (08): (BERLIN) ONGOING INVESTIGATIONS
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri 13 Jul 2012
From: George, Maja <GeorgeM@rki.de> [edited]
Update on 3rd confirmed case of anthrax in an injecting drug user
Although incomplete, the molecular typing of _Bacillus anthracis_ DNA from the 3rd German (Berlin) case of anthrax in an injecting drug user (IDU) in Berlin suggests that it could be genetically similar to the 1st 2 cases in the Regensburg region and to the 2009/2010 outbreak strain from the United Kingdom and Germany.
One of the 2 indicative single nucleotide polymorphism (SNP) markers (SNP1173928, Price et al., 2012) showed the expected pattern. Although this SNP is of specific interest for the identification of isolates, the definite identification of the strain isolated from the patient cannot be completed due to the limited amount of DNA. The early antibiotic treatment of the patient did not allow the isolation of living bacteria, which would have been the best source for a sufficient amount of DNA. The state of the science typing would at least include the analysis of one more highly specific SNP region and 13 other SNP regions (Van Ert et al., 2007).
The case had presented on 17 Jun  at a Berlin hospital with severe soft tissue infection at a heroin injection site. The infection with _B. anthracis_ was confirmed by real-time PCR on a specimen from a necrotic ulcer and by positive serology for specific anthrax toxin antibodies performed at the Robert Koch Institute (RKI).
In conclusion, there is currently no evidence conflicting with the hypothesis that the 3 German cases are linked to the same still active source of infection since the outbreak 2009/2010 in the United Kingdom and Germany.
Additional information in German is published on the website of the Robert Koch Institute at http://www.rki.de/DE/Content/InfAZ/A/Anthrax/aktuell.html
PD Dr Roland Grunow <GrunowK@rki.de>
Robert Koch Institute
Centre for Biological Security
Highly Pathogenic Microorganisms Laboratory (ZBS2)
Dr. Helen Bernard <BernardH@rki.de>
Robert Koch Institute
Department for Infectious Disease Epidemiology Division 35 (Gastrointestinal Infections, Zoonoses and Tropical Infections)
The Robert Koch Institute is a Federal Institute within the portfolio of the Federal Ministry of Health.
[We much appreciate our German colleagues providing this authoritative account of the status of the RKI investigations. If our experience of the heroin associated cases in 2010 in Scotland is relevant, the appearance of new cases in this 2012 series will be drawn out. - Mod.MHJ
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2HYi.]