Photo Quiz; Anthrax or Orf?

N. Tulek, Esra Kaya Kılıç, G. Ertem, Esra Yüksekkaya, Ankara Training Clinical Microbiology
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Abstract

A 38-year-old man presented to the hospital with complaints of fever and multiple lesions on his face, hands, and arms. The lesions were appeared five days earlier before admission as painless small papules and developed into larger lesions with the darkish center. He was experiencing a fever for the last 24 hours. He was a farmer, he sacrificed and butchered a bull at the Eid al-Adha, ten days ago. He reported that he was healthy previously and did not use any drug. On physical examination, his body temperature was 39°C. He had multiple lesions on arms, hands, face and erythematous diffuse edema on his right hand, on 4th finger extending to the arm. There were some satellite lesions on the left arm (Figure1, 2), as well. He had a red lymphangitic streak on the right arm that extended from the hands toward the axillae with a palpable and tender axillary lymph node 2 cm in diameter. Laboratory examination revealed white blood count 11600 cells/μL with left shift, and C-reactive protein 85 mg/ dL (N: 0-5). Aspiration material was obtained from the lesion on the 4th finger, stained with Gram stain and cultured.
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照片测验;炭疽还是口蹄疫?
一名38岁男性以发热和面部、手部和手臂多发病变主诉就诊。该病变于入院前5天出现,为无痛性小丘疹,后来发展为较大的病灶,中心呈黑色。过去24小时他一直在发烧。他是个农民,十天前,他在宰牲节上宰杀了一头公牛。他报告说,他以前很健康,没有使用任何药物。体格检查体温39℃。手臂、手部、面部多处病变,右手4指至上臂红斑性弥漫性水肿。左臂也有一些卫星病变(图1,2)。患者右臂有一红色淋巴管条纹,从手向腋窝延伸,腋窝淋巴结直径2厘米,可触及且柔软。实验室检查:白细胞11600个/μL,左移,c -反应蛋白85 mg/ dL (N: 0 ~ 5)。取4指病变部位吸出材料,革兰氏染色培养。
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