颜面部皮肤炭疽9例的诊断与治疗

Nine cases of facial cutaneous anthrax: diagnosis and treatment

目的观察颜面部皮肤炭疽的临床特征及其诊断和治疗。方法对收治的9例颜面部皮肤炭疽的临床表现及诊治方法进行分析和总结。结果 9例患者均有流行病学接触史;症状表现为病变部位最初出现红色丘疹,2～3天出现水疱,周围组织水肿,水疱破裂后出现局部组织坏死。其中7例形成典型的1～3 cm直径大小的黑色焦痂。病变部位分泌物直接涂片镜检均可见革兰阳性粗大杆菌。9例患者均给予青霉素钠静脉滴注,并高锰酸钾溶液局部湿敷,其中5例联用乳酸左旋氧氟沙星静脉滴注,3～6周后均痊愈。结论根据流行病学接触史、典型的临床表现,结合病原学检查可对颜面部皮肤炭疽做出明确的诊断,临床治疗药物首选青霉素。

Objective To investigate clinical features, diagnosis and treatment of facial cutaneous anthrax. Methods The clinical manifestation and treatment of 9 patients with facial cutaneous anthrax were analyzed and then summarized. Results All the paitnets were confirmed to have epidemio!ogical exposure. Red papules were the initial symptom of the lesion. Two orthree days later, vesicles developed with surrounding tissue edema. After vesicles ruptured,local tissue progressed to necrosis. Characteristic eschar with diameter of 1 to 3 cm were observed in 7 cases. Gram-positive thick bacilli could be detected in the secretion from the lesion under mi- croscopy in all cases. All 9 patients were treated with penicillin intravenously and hydropathic compress with potassium permanganate solution. Besides,5 patients received combined treatment with levofloxacin intravenously. All the patients recovered after 3 to 6 weeks treatment. Conclusion Facial cutaneous anthrax could be diagnosed by epidemiological exposure history,typical clinical features and etiological examination. Penicillin is the preferred medicine for anthrax.