Anthrax is extremely rare in the western world but is endemic to areas of south and central Asia. In early 2010 an outbreak was identified in heroin-injecting intravenous drug users in the United Kingdom and Europe. Afghanistan is currently the principal source of heroin which reaches the United Kingdom. When anthrax occurs, cutaneous disease accounts for over 95% of cases. At least 47 cases with 13 deaths have been confirmed so far. We present three cases presenting during this time with marked swelling, one resulting in compartment syndrome but all with an absence of the expected cutaneous appearances.

We suggest that rather than cutaneous anthrax, these patients represent a new subcutaneous presentation of anthrax.

Background: Spinal infections are rare, the reported incidence in the UK is between 1:50,000 and 1 in 250,000. Functional outcome following spinal infection is not widely reported in the literature

Methods: Over a 7-year period, all adult patients presenting to a tertiary referral centre with a diagnosis of primary pyogenic spinal infection (epidural abscess, osteomyleitis or spondylodiscitis) were identified. Data at presentation was collected and included: C-reactive Protein (CRP), white cell count (WCC), time interval between onset of symptoms and presentation to tertiary referral centre causative organism, level of spinal infection and surgery. Functional outcome was assessed using a validated tool – The Oswestry Disability Index (ODI)

Results: 96 patients were identified, mean age 61 years (22–87), 51 (53%) male. ODI was available for 78% of live patients; the mean follow-up period being 5.5 years (21–120 months). The median ODI was 42 (0–84). An elevated CRP was significantly associated with a poorer functional outcome (p=0.05). Surgical intervention was related to improved functional outcome but did not reach statistical significance. WCC and the presence of an abscess were not related to functional outcome.

Conclusion: In out study we have found that the higher the CRP at presentation the poorer the functional outcome.