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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 DNA in eschar fragments from both patients. T-cell specific immunity was studied by flow cytometry and Elispot assay after stimulation with 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.

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/content/10.2807/1560-7917.ES.2019.24.24.1800685
2019-06-13
2024-05-15
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.24.1800685
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Unexpected human cases of cutaneous anthrax in Latium region, Italy, August 2017: integrated human–animal investigation of epidemiological, clinical, microbiological and ecological factors
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Emanuele+Nicastri&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nicastri Emanuele</a>, <a href="/search?value1=Francesco+Vairo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vairo Francesco</a>, <a href="/search?value1=Paola+Mencarini&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mencarini Paola</a>, <a href="/search?value1=Antonio+Battisti&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Battisti Antonio</a>, <a href="/search?value1=Chiara+Agrati&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Agrati Chiara</a>, <a href="/search?value1=Eleonora+Cimini&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cimini Eleonora</a>, <a href="/search?value1=Stefania+Carrara&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Carrara Stefania</a>, <a href="/search?value1=Silvia+D%E2%80%99Arezzo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">D’Arezzo Silvia</a>, <a href="/search?value1=Rosanna+Adone&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Adone Rosanna</a>, <a href="/search?value1=Antonella+Vulcano&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vulcano Antonella</a>, <a href="/search?value1=Marco+Iannetta&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Iannetta Marco</a>, <a href="/search?value1=Alessandro+Capone&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Capone Alessandro</a>, <a href="/search?value1=Nicola+Petrosillo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Petrosillo Nicola</a>, <a href="/search?value1=Antonio+Fasanella&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fasanella Antonio</a>, <a href="/search?value1=Giuseppe+Ippolito&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ippolito Giuseppe</a>, <a href="/search?value1=Italian+Anthrax+Team+members&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Italian Anthrax Team members</a></span>. Unexpected human cases of cutaneous anthrax in Latium region, Italy, August 2017: integrated human–animal investigation of epidemiological, clinical, microbiological and ecological factors. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(24):pii=1800685. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.24.1800685" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.24.1800685</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 16 Dec 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 27 Feb 2019 </span> </p>
/content/10.2807/1560-7917.ES.2019.24.24.1800685
/content/10.2807/1560-7917.ES.2019.24.24.1800685
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