Cutaneous anthrax of the eyelid

DM Thappa, K Karthikeyan, V Anand Rao

 Detp. of Dermatology, Venereology & Leprology and Ophthalmology, JIPMER, Pondicherry - 605 006, India

Correspondence Address:
D M Thappa
Detp. of Dermatology, Venereology & Leprology, JIPMER, Pondicherry - 605 006
India

To the Editor,

Anthrax is a zoonosis caused by Bacillus anthrocis. Man is an incidental host and usually acquires it as a result of contact with infected domestic animals a contaminated animal products.[1] It usually occurs in it: cutaneous form. We herewith report an agricultural labore with cutaneous anthrax of the eyelid who was part of c series of 23 cases of cutaneous anthrax seen at JIPMER hospital, Pondicherry from July 1998 to July 2001 due to at endemic outbreak of anthrax.

A 20-year-old female, an agricultural laborer had a painless ulcer on the left lower eyelid of 7 day duration. There was history of multiple cattle deaths in the neighborhood. On examination, she was afebrile. Her left lower eyelid showed 3x4 cm ulcer covered by c hemorrhagic eschar [Figure - 1]. She had diffuse gelatinous non-pitting edema of the eyelids that extended on the whop of the face and neck. She was unable to open her left eye however, her visual acuity was normal and ocula movements were full. The cervical lymph nodes were enlarged and tender.

Gram′s stain of smear taken from the ulcer shower large Gram positive bacilli in short chains, with typicc ′box-car′ appearance suggestive of Bacillus anthracis with scanty pus cells, however, culture of the exudate from the skin lesion as well as from blood did not yield the organism. All other routine investigations were within normal limits. Based on the above findings, a diagnosis of cutaneous anthrax with preseptal cellulitis was made. Patient was treated with intravenous penicillin G2 million units every 6 hourly for 2 weeks. In spite of therapy, her skin lesion progressed to eschar stage and finally healed with scarring.

Anthrax is a disease of great actiquity and still remains endemic in central Africa, India, South East Asia, Middle East and East Europe where conditions favor an animal-soil-animal cycle.[1] The incidence of anthrax probably correlates with enzoonotic status of the disease in livestock in these countries. A few sporadic cases and outbreaks of anthrax have occurred in India, but the incidence in animals and in man is not accurately known. We recorded 15 cases of cutaneous anthrax between July 1998 to September 2000 at JIPMER hospital, Pondicherry and an additional 8 cases till July 2001.

Thus, cutaneous anthrax is still a reality in India and it accounts for the majority of anthrax cases.[1] In the face, the eyelid is the most common site of infection.[2] It needs to be differentiated from other eyelid and orbital infections, since eyelid anthrax can lead to serious complications like cicatrization and ectropion.[2],[3]

1.	Thappa DM, Karthikeyan K. Anthrax: An overview with the Indian subcontinent. Int J Dermatol 2001; 40:216-222. [Google Scholar]
2.	Soysal GH, Kirath H, Recep OF. Anthrax as the cause of preseptal cellulitis and cicatricial ectropion, Acta Ophthalmol Scand 2001; 79: 208-209. [Google Scholar]
3.	Sarada D, Valentina GO, Lalitha MK. Cutaneous anthrax involving the eyelids, Indian J Med Microbial 1999; 17:92-95. [Google Scholar]