Unexpected human cases of cutaneous anthrax in Latium region, Italy, August 2017

integrated human-animal investigation of epidemiological, clinical, microbiological and ecological factors

Research output: Contribution to journalArticle

Abstract

On 31 August, a veterinarian and a farmworker were hospitalised for skin lesions. Both had been exposed to a dead cow on 19 August on a farm near Rome, where eight further cattle died of confirmed anthrax later the same month. At admission, the first case showed a black depressed eschar and another smaller lesion on one hand. The second case presented deep infection of the skin, with involvement of both arms. Anthrax diagnosis was confirmed by detection of B. anthracis DNA in eschar fragments from both patients. T-cell specific immunity was studied by flow cytometry and Elispot assay after stimulation with B. anthracis secretome in blood samples collected from Case 1. Immunoglobulin production was detected by complement fixation assay. In Case 1, specific CD4+ T-cell activation was detected, without antibody production. Specific antibodies were detected only in the second patient with severe cutaneous illness. Both patients recovered. The two human anthrax cases were epidemiologically linked, but anthrax was not suspected at admission in either case. The veterinarian had initially unrecognised professional exposure and the exposed farmworker did initially not report exposure to affected animals. A One Health strategy integrating human and animal investigations was essential to confirm the diagnosis.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalEuro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin
Volume24
Issue number24
DOIs
Publication statusPublished - Jun 1 2019

Fingerprint

Anthrax
Italy
Veterinarians
Skin
T-Lymphocytes
Antibody Formation
Immunoglobulins
Immunity
Flow Cytometry
Cutaneous anthrax
Antibodies
DNA
Infection
Farmers

Keywords

  • anthrax
  • Bacillus anthracis
  • cutaneous anthrax
  • Italy
  • outbreaks
  • surveillance
  • zoonotic infections

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health
  • Virology

Cite this

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title = "Unexpected human cases of cutaneous anthrax in Latium region, Italy, August 2017: integrated human-animal investigation of epidemiological, clinical, microbiological and ecological factors",
abstract = "On 31 August, a veterinarian and a farmworker were hospitalised for skin lesions. Both had been exposed to a dead cow on 19 August on a farm near Rome, where eight further cattle died of confirmed anthrax later the same month. At admission, the first case showed a black depressed eschar and another smaller lesion on one hand. The second case presented deep infection of the skin, with involvement of both arms. Anthrax diagnosis was confirmed by detection of B. anthracis DNA in eschar fragments from both patients. T-cell specific immunity was studied by flow cytometry and Elispot assay after stimulation with B. anthracis secretome in blood samples collected from Case 1. Immunoglobulin production was detected by complement fixation assay. In Case 1, specific CD4+ T-cell activation was detected, without antibody production. Specific antibodies were detected only in the second patient with severe cutaneous illness. Both patients recovered. The two human anthrax cases were epidemiologically linked, but anthrax was not suspected at admission in either case. The veterinarian had initially unrecognised professional exposure and the exposed farmworker did initially not report exposure to affected animals. A One Health strategy integrating human and animal investigations was essential to confirm the diagnosis.",
keywords = "anthrax, Bacillus anthracis, cutaneous anthrax, Italy, outbreaks, surveillance, zoonotic infections",
author = "Emanuele Nicastri and Francesco Vairo and Paola Mencarini and Antonio Battisti and Chiara Agrati and Eleonora Cimini and Stefania Carrara and Silvia D'Arezzo and Rosanna Adone and Antonella Vulcano and Marco Iannetta and Alessandro Capone and Nicola Petrosillo and Antonio Fasanella and Giuseppe Ippolito and {Italian Anthrax Team Members}, {Anthrax Team Members}",
year = "2019",
month = "6",
day = "1",
doi = "10.2807/1560-7917.ES.2019.24.24.1800685",
language = "English",
volume = "24",
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journal = "Eurosurveillance",
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T1 - Unexpected human cases of cutaneous anthrax in Latium region, Italy, August 2017

T2 - integrated human-animal investigation of epidemiological, clinical, microbiological and ecological factors

AU - Nicastri, Emanuele

AU - Vairo, Francesco

AU - Mencarini, Paola

AU - Battisti, Antonio

AU - Agrati, Chiara

AU - Cimini, Eleonora

AU - Carrara, Stefania

AU - D'Arezzo, Silvia

AU - Adone, Rosanna

AU - Vulcano, Antonella

AU - Iannetta, Marco

AU - Capone, Alessandro

AU - Petrosillo, Nicola

AU - Fasanella, Antonio

AU - Ippolito, Giuseppe

AU - Italian Anthrax Team Members, Anthrax Team Members

PY - 2019/6/1

Y1 - 2019/6/1

N2 - On 31 August, a veterinarian and a farmworker were hospitalised for skin lesions. Both had been exposed to a dead cow on 19 August on a farm near Rome, where eight further cattle died of confirmed anthrax later the same month. At admission, the first case showed a black depressed eschar and another smaller lesion on one hand. The second case presented deep infection of the skin, with involvement of both arms. Anthrax diagnosis was confirmed by detection of B. anthracis DNA in eschar fragments from both patients. T-cell specific immunity was studied by flow cytometry and Elispot assay after stimulation with B. anthracis secretome in blood samples collected from Case 1. Immunoglobulin production was detected by complement fixation assay. In Case 1, specific CD4+ T-cell activation was detected, without antibody production. Specific antibodies were detected only in the second patient with severe cutaneous illness. Both patients recovered. The two human anthrax cases were epidemiologically linked, but anthrax was not suspected at admission in either case. The veterinarian had initially unrecognised professional exposure and the exposed farmworker did initially not report exposure to affected animals. A One Health strategy integrating human and animal investigations was essential to confirm the diagnosis.

AB - On 31 August, a veterinarian and a farmworker were hospitalised for skin lesions. Both had been exposed to a dead cow on 19 August on a farm near Rome, where eight further cattle died of confirmed anthrax later the same month. At admission, the first case showed a black depressed eschar and another smaller lesion on one hand. The second case presented deep infection of the skin, with involvement of both arms. Anthrax diagnosis was confirmed by detection of B. anthracis DNA in eschar fragments from both patients. T-cell specific immunity was studied by flow cytometry and Elispot assay after stimulation with B. anthracis secretome in blood samples collected from Case 1. Immunoglobulin production was detected by complement fixation assay. In Case 1, specific CD4+ T-cell activation was detected, without antibody production. Specific antibodies were detected only in the second patient with severe cutaneous illness. Both patients recovered. The two human anthrax cases were epidemiologically linked, but anthrax was not suspected at admission in either case. The veterinarian had initially unrecognised professional exposure and the exposed farmworker did initially not report exposure to affected animals. A One Health strategy integrating human and animal investigations was essential to confirm the diagnosis.

KW - anthrax

KW - Bacillus anthracis

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KW - Italy

KW - outbreaks

KW - surveillance

KW - zoonotic infections

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