A report of a successful One Health approach in Calabria region (Italy)

In this report, three cases of human cutaneous anthrax, one complicated by meningitis, occurred near Vibo Valentia (Calabria, Italy), in a rural area where no animals anthrax outbreaks have been reported in the last decades.

All cases were linked to a single infected bullock.

A 41 year old male truck driver, along with two male slaughterhouse workers, ages 45 and 42 years, were hospitalized for necrotic lesions of the arm associated with edema of the limb and high fever (40°C). All three patients were involved in transporting a bullock to the slaughterhouse.

Microbiological examination on the prescapular lymph node and a piece of muscle from the bullock carcass showed the presence of Bacillus anthracis.

The three patients underwent a biopsy of the affected tissues, and all samples tested positive for B.  anthracis using PCR test.

Furthermore, the truck driver also complained of an intense headache; a cerebrospinal fluid sampling was carried out giving positive result for B. anthracis by PCR test and confirming the presumptive diagnosis of meningitis.

Fast diagnosis and appropriate treatment are crucial for the management of human anthrax. Cooperation and collaboration between veterinary and public health services was successful in diagnosing and resolving three cases of cutaneous human anthrax, confirming the reliability of One Health approach for the surveillance of zoonoses.

Anthrax is a zoonosis caused by Bacillus anthracis, a Gram-positive, aerobic, sporeforming bacillus. Animals can become infected by ingesting spores from contaminated soil or feed. Spillover to humans is usually due to direct contact with infected animals or animal products, and it can manifest as cutaneous (contact), gastrointestinal (ingestion), or respiratory (inhalation) anthrax.

In addition, injectional anthrax has been reported among drug abusers, attributed to contaminated heroin. All clinical forms, if untreated, could evolve into systemic anthrax. Cutaneous anthrax is the most common form described in humans, and in Italy, other cases have been described in the past. About one third of systemic disease is complicated by meningitis, characterized by a fatality rate of 92.3%.

In Europe, several anthrax outbreaks have recently been described among wild or domestic herbivores, usually occurring in late spring or summer, when high temperatures follow copious rainfalls.

In Italy, anthrax is typically a sporadic disease, particularly occurring during the summer in the central and southern regions, and in the major islands, where it almost exclusively affects pastured animals.

Climatic conditions could affect soil suitability for anthrax, and climate change could be responsible for increased anthrax outbreaks in temperate regions in the near future.

Sporadic outbreaks of human anthrax have occurred in European countries during the last decades, mainly due to occupational exposure to infected animals, and very few cases of anthrax meningitis have been reported.

Fonte: An Outbreak of Human Systemic Anthrax, including One Case of Anthrax Meningitis, Occurred in Calabria Region (Italy): A Description of a Successful One Health Approach

By Maurizio Guastalegname et al.