7例皮肤炭疽患者影像学表现及临床诊疗分析

Clinical imaging manifestations and diagnostic analysis of seven cases of anthrax

目的探讨皮肤炭疽患者的影像学表现及临床诊治方法,提高对炭疽病的认识。方法回顾性分析和总结2015年10月至2020年7月昆明市第三人民医院收治的7例皮肤炭疽患者的流行病学史、临床表现、实验室检查、影像学检查与诊断及治疗方法。结果在3起疫情中,接触病牛羊者共14人,其中7例发病,男性6例,女性1例;回族4例,汉族3例;年龄35~60岁,中位年龄46岁;发病时间多在接触后7d内。患者的皮损最早出现在其手及前臂处,6例表现为丘疹,1例为原有手部伤口基础上流液、流脓,并依次出现透明疱疹,周围组织肿胀,伴有焦痂形成,1例患者并发骨筋膜室综合征;5例(71.4%)外周血白细胞总数及中性粒细胞计数升高,6例(85.7%)C反应蛋白升高;2例(28.6%)伤口分泌物革兰氏阳性菌培养阳性;6例患者行胸部CT,均表现为患侧腋窝多发淋巴结肿大并淋巴结周围炎,并发骨筋膜室综合征患者行上肢CT扫描检查,表现为患肢软组织肿胀;7例患者经高锰酸钾局部湿敷和青霉素为主的抗感染治疗,并发骨筋膜室综合征者行负压封闭引流技术,所有患者均痊愈。结论皮肤炭疽患者有明确病畜接触史且皮肤表现典型,影像学CT表现为患侧腋窝淋巴结肿大及淋巴结周围炎改变;实验室检查白细胞计数、中性粒细胞、C反应蛋白升高;早期局部治疗与全身足量应用抗生素为首要治疗方案。

Objective To exploring the imaging manifestations and clinical course of patients with cutaneous anthrax,and to improve the understanding of anthrax.Method Retrospective analysis and summary of the epidemiological history,clinical manifestations,laboratory tests,imaging and treatment of seven patients with cutaneous anthrax admitted to the Third People's Hospital of Kunming from October 2015 to July 2020.Result In the three outbreaks,a total of 14 people were exposed to diseased cattle or sheep,of whom 7 developed the cutaneous anthrax.The patients were 6 males and 1 female,4 Hui and 3 Han,aged 35-60 years,with a median age of 46 years;the onset was mostly within 7 days after exposure;the lesions first appeared on the hands and forearms,with 6 cases showing papules,1 case with fluid and pus flowing on the basis of the original hand wound,and in turn with clear herpes,swelling of the surrounding tissues with scab formation,and 1 patient with osteofascial compartment syndrome.Five patients(71.4%)had elevated total peripheral blood leukocyte and neutrophil counts,and six patients(85.7%)had elevated C-reactive protein;two patients(28.6%)had positive Gram-positive bacterial culture of wound secretions;six patients underwent chest CT,all of which showed multiple lymph node enlargement and perilymph node inflammation in the affected axilla,and patients with complicated osteofascial compartment syndrome underwent CT of the upper limbs,which showed soft tissue swelling of the affected limbs.Seven patients were treated with local wet compresses of potassium permanganate and penicillin-based anti-infective therapy,and those with osteofascial compartment syndrome underwent vacuum sealing drainage,all patients were cured.Conclusion Patients with cutaneous anthrax have a clear history of contact with diseased animals and typical skin manifestations;imaging CT examination shows enlarged axillary lymph nodes and perilymph node inflammation;laboratory tests show elevated white blood cell count,neutrophils,and C-reactive protein;early local treatment and full application of antibiotics are the primary treatment.