Objective

Although olfaction is often compromised by such factors as head trauma, viruses, and toxic agents, the olfactory epithelium and sectors of the olfactory bulb have the potential for regeneration. This study assessed the degree to which olfactory function changes over time in patients presenting to a university-based smell and taste center with complaints of olfactory dysfunction and the influences of etiology (eg, head trauma, upper respiratory infection), sex, age, smoking behavior, degree of initial dysfunction, and other factors on such change.



Methods

Well-validated odor identification tests were administered to 542 patients on 2 occasions separated from one another by 3 months to 24 years. Multivariable regression and χ2 analyses assessed the influences of the variables on the longitudinal changes in olfactory test scores.



Results

On average, smell test scores improved modestly over time. Patient age, severity of initial olfactory loss, and the duration of dysfunction at first testing were significant predictors of the amount of the change. Etiology, sex, time between the two test administrations, and initial smoking behavior were not significant predictors. The percentage of anosmic and microsmic patients exhibiting statistically significant change in function was 56.72 and 42.86%, respectively. However, only 11.31% of anosmic and 23.31% of microsmic patients regained normal age-related function over time.



Interpretation

Some recovery can be expected in a significant number of patients who experience smell loss. The amount of recovery depends on the degree of initial loss, age, and the duration of loss. Etiology, per se, is not a significant determinant of prognosis, in contrast with what is commonly believed. Ann Neurol 2007

Predictors of prognosis in patients with olfactory disturbance.

Anthrax vaccination strategies.

Anthrax vaccine adsorbed (AVA; BioThrax), the current FDA-licensed human anthrax vaccine, contains various amounts of the three anthrax toxin components, protective antigen (PA), lethal factor (LF), and edema factor (EF). While antibody to PA is sufficient to mediate protection against anthrax in animal models, it is not known if antibodies to LF or EF contribute to protection in humans. Toxin-neutralizing activity was evaluated in sera from AVA-vaccinated volunteers, all of whom had antibody responses to LF and EF, as well as PA. The contribution of antibodies to LF and EF was assessed using mouse macrophage J774A.1 cells by examining neutralization of LF-induced lysis using alamarBlue reduction and neutralization of EF-induced cyclic AMP increases by enzyme-linked immunosorbent assay. Antibody responses to LF and EF were low compared to those to PA, and the amount of LF or EF in the assay could exceed the amount of antibodies to LF or EF. Higher titers were seen for most individuals when the LF or EF concentration was limiting compared to when LF or EF was in excess, initially suggesting that antibody to LF or EF augmented protection. However, depletion of LF and EF antibodies in sera did not result in a significant decrease in toxin neutralization. Overall, this study suggests that AVA-induced LF and EF antibodies do not significantly contribute to anthrax toxin neutralization in humans and that antibodies to PA are sufficient to neutralize toxin activity.

Neutralizing Activity of Vaccine-Induced Antibodies to Two Bacillus anthracis Toxin Components, Lethal Factor and Edema Factor

A review of the literature suggests that the major neurologic symptom complex of infection by Bacillus anthracis is a fulminant and rapidly fatal hemorrhagic meningoencephalitis and that the reported initial mode of entry can be via the cutaneous or inhalation route. For febrile patients with acute neurologic deterioration with associated findings of dark necrotic pustules on the extremities, gram-positive rods in the cerebrospinal fluid, and multifocal areas of unexplained intracerebral hemorrhage on computed tomographic scans, anthrax should be considered within the differential diagnosis. A low cerebrospinal fluid glucose level has been reported, with gram-positive rods often noted on the gram stain of the cerebrospinal fluid in severely affected patients. Reports indicate that death usually occurs within a week.

https://jamanetwork.com/journals/jamaneurology/articlepdf/783965/nnr20002.pdf

Neurologic Complications of Anthrax: A Review of the Literature

Background:The initial presentation of pyoderma gangrenosum (PG) is virtually indistinguishable from a pyogenic infection, making debridement appear necessary. However, operative approaches often lead to exacerbation and rapid extension through pathergy.Objective and Methods:In attempts to increase awareness of this condition and minimize misdiagnoses, a review of published reports involving PG of the hand and digits was performed and included 35 patients in addition to our case of a 14-year-old female with a history of ulcerative colitis.Results:Of the total cases, 29 patients were misdiagnosed as having an infection and subsequently treated with antibiotics; 13 of these patients also had debridement of their lesions. Twenty-eight patients had associated medical conditions, including ulcerative colitis, Crohn disease, diabetes mellitus, and cancer.Conclusion:When approached with a rapidly growing ulcerated lesion that does not respond to operative therapy, the possibility of PG should be entertained and ...

Pyoderma gangrenosum: the great pretender and a challenging diagnosis.

The Anthrax Vaccine Immunization Program is a Department of Defense initiative to protect military personnel against the threat of anthrax. Surveillance for adverse events associated with anthrax vaccination has shown that mild local reactions are not uncommon while systemic reactions are extremely rare. We present a case of a 26-year-old male with delayed-type hypersensitivity after two doses of anthrax vaccine.

/pdf/delayed-type-hypersensitivity-reaction-to-anthrax-vaccine-1ul4hxk2gs.pdf

Delayed-type hypersensitivity reaction to anthrax vaccine.

A 49-year-old man was referred for dermatologic examination because of a 10-year history of episodic painful ulcerations on his upper extremities lasting 10 days. Physical examination showed symmetrically located ulcerations of both ring fingers, measuring about 18 mm in diameter on the left hand and 10 mm on the right hand. The ulcers had irregular raised borders and central granulation tissue. Laboratory tests disclosed slight elevation of liver enzyme levels. During a blood drive several years earlier, the patient had been notified of a positive test reaction to hepatitis C virus but had received no further medical evaluation. Results of wound cultures were positive for Staphylococcus aureus and Candida albicans. A 4-mm punch biopsy of an inflamed area adjacent to one of the ulcers was performed. Histologic examination revealed mixed superficial and deep inflammatory infiltrate with extravasation of red blood cells. Results of bacterial cultures, including acid-fast bacilli culture, were negative. Fungal culture produced C albicans, which was presumed to be a contaminant. ---------......,

More than a hand infection. Pyoderma gangrenosum.

/pdf/pseudofolliculitis-of-the-beard-2fv25217pn.pdf

Beth A. Honl

Papers

Delayed-type hypersensitivity reaction to anthrax vaccine.

More than a hand infection. Pyoderma gangrenosum.

Pseudofolliculitis of the Beard