A series case study on anthrax cases in five hospitals in North China
Objective To conduct a series case study on hospitalized anthrax cases in five hospitals in North China,to share clinical experiences in the diagnosis and treatment of cutaneous and pulmonary anthrax.Methods A retrospective,multicenter cohort study was conducted on the anthrax patients admitted to five hospitals in North China from August 2018 to March 2022.Forty patients were divided into severe and mild groups.The clinical features,treatment and prognosis of the patients were collected and analysed.Statistical evaluations included independent sample t test,Mann-Whitney U test,and chi-square test.Results Among the 40 patients with anthrax,10(25.0％)were severely ill and 30(75.0％)were mildly ill.According to the sites of infection,40 patients were classified as 39 cutaneous anthrax cases(one case had secondary pulmonary anthrax)and one pulmonary anthrax case.The rates of chills and fever,lymphadenopathy,liver dysfunction and hypoalbuminemia in the severe group were all higher than those in the mild group,with statistically significant differences(x2=5.71,6.54,4.68 and 9.22,respectively,all P＜0.05).The peripheral white blood cell count,neutrophil count,neutrophil/lymphocyte ratio and C-reactive protein were(11.8±4.9)× 109/L,(9.5±5.1)×109/L,8.6±7.3,27.9(8.6,167.7)mg/L,respectively,which were all higher than those in mild disease group((7.5±2.4)× 109/L,(5.0±2.1)×109/L,3.2±2.3,3.5(1.2,14.7)mg/L),with statistically significant differences(t=2.66,t=2.71,t=2.32 and Z=-3.01,respectively,all P＜0.05).The albumin level in the severe group was(35.5±8.1)g/L,which was lower than that of the mild group((43.7±3.2)g/L),and the difference was statistically significant(t=-3.13,P=0.011).The severe cases were more likely to have skin lesions greater than four centimetre in diameter,multiple,vesicular,or edematous,with a significant difference(x2=6.01,P=0.014).Among 39 patients with cutaneous anthrax,28(71.8％)in the mild group were treated with penicillin alone,and nine(23.1％)in the severe group were treated with penicillin,ofloxacin,piperacillin/tazobactam combined with one of linezolid,doxycycline,or clindamycin for anti-infection treatment.The two patients with pulmonary anthrax were treated with closed thoracic drainage for pleural effusion and pneumothorax,and were treated with two bactericidal and one protein synthesis inhibitor antibiotics.All 40 anthrax patients were cured and discharged from hospital.Conclusions Patients with mild cutaneous anthrax can generally be treated with single penicillin,and patients with severe cutaneous anthrax and pulmonary anthrax should be treated with combined antibiotics.
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