Background: Anthrax is a zoonotic bacterial infection caused by a gram-positive bacillus called Bacillus anthracis. It is a disease of public health importance because of its attending mortality which could approach absolute without treatment, and about 46% in the best of centre; and also because of its role as a biological weapon and in bioterrorism, post 9-11 in the United States, anthrax spores had been deliberately released in mail parcel leading to a significant morbidity and mortality. The most feared manifestation of anthrax is pulmonary anthrax, which had the aforementioned statistics. Other manifestations include cutaneous anthrax, gastrointestinal, and injection anthrax.
Objective: To report four cases of cutaneous anthrax seen in Kamakwie, Karene District, Northern Sierra Leone, by illustrating their clinical presentations and management, in order to draw attention to the problem.
Method: Four cases of cutaneous anthrax were seen at Wesleyan Hospital, Kamakwie between the 7th June, 2018 and 11th July, 2018. The diagnosis was suspected from clinical interview and examination, and confirmed by Enzyme-linked Immunoasorbent assay (ELISA) at Infectious disease[Ebola] Reference centre in Kenema, Sierra Leone.
Results: The age range of the cases was between 9 months and 20 years. Three of the cases were females and one male. All the cases had contact with cattle directly by virtue of animal care and milking, and indirectly by staying on the farmstead with the animals. One of the cases followed routine vaccination. All the cases presented with pustular or vesicular rash which later became ulcerated with central area of eschar. The duration of time between the onset of the rash and formation of the ulcers ranges from one day to three days. Other features were low grade fever, peri-lesional swelling, peri-ocular swelling, malaise, weight loss and loss of appetite. Majority of the ulcers were located in the head and neck region. Treatment of the cases with antibiotics and prophylaxis for the close contacts, as well as decontamination of the animal reservoir yielded a good result with 0% mortality. However, duration of hospital stay ranges from 14 days to 20 days.
Conclusion: Human vaccination especially for individuals whose work bring them in contact with animals or animal products, coupled with animal vaccination will be a more economic way in mitigating against this disease bearing in mind the associated morbidity and mortality associated with it.
