Anthrax

Cute little guy, isn't he?

Caroline, 10, presented with an edematous face, her eyes swollen closed. She had no fever, but she had a raised circular lesion in the center of her forehead. It was necrotic at the perimeter, pus-filled in the center, and measured about 5 centimeters. The child reported in precise schoolgirl English, "I was beaten (bitten) by something at night one week ago."

We've seen several cases of anthrax here, but they've been isolated incidences. Cutaneous anthrax is caused by spores in the soil from infected livestock -- usually cows, goats or sheep. The spores, often carried on animal hair, infect a person's skin, usually through a small cut or pimple -- in this case, probably an insect bite. The wound fulminates into an unsightly, but painless, raised crater which may take months to heal.

In spite of its grotesque appearance, cutaneous anthrax (with a 20% mortality rate) is far less deadly than the airborne variety, and it is readily treated with long-term oral antibiotics. We cleaned Caroline's wound, applied a clean gauze dressing, prescribed Ciprofloxacin for 60 days and sent her home. We also asked Mama Caroline to alert her neighbors about the possibility of sick livestock making other people ill in the community.

I'm in the habit of petting the hospital's friendly cows and goats, en route to daily ward rounds. The gentle creatures provide both milk and meat for our patients. I'm also in the habit of using hand sanitizer now. Unfortunately, 99.9% of Kenyans don't have any.