[ZKKL] Academic Sharing | Recent Advances in Research on the Correlation Between HLA and the Pathogenesis of SLE

2.1 Clinical Manifestations A 50-year-old male herder was admitted for evaluation of fever and headache lasting four days, along with altered mental status for one day and left upper‑extremity swelling. On admission, he exhibited fluid–electrolyte imbalance, a lethargic state, confusion, intermittent seizures, urinary incontinence, and maintained an upright posture. Physical examination revealed: temperature 37.7°C, pulse 112 beats/min, respiration 29 breaths/min, blood pressure 133/84 mmHg; heart rate 85 beats/min; SpO₂ 83%. The left forearm showed widespread edema, with several 1.5 mm × 1.5 mm eschar‑like skin lesions on the fourth digit and dorsum of the hand, oozing purulent‑bloody discharge. Ulcerated margins were slightly elevated above normal skin, with scattered vesicles around the lesions. Superficial lymph nodes were not palpable. Both eyes exhibited right‑ward deviation; pupils were equal in size and round. Neck was nuchal rigidity; lung sounds were coarse, with crackles and rhonchi audible in both lungs. Heart rhythm was regular, with strong heart sounds; cardiac dullness was unremarkable. Abdomen was flat, and the Babinski sign was weakly positive bilaterally. Laboratory findings included: WBC 13.4 × 10⁹/L, neutrophils 0.952, lymphocytes 0.029; RBC 4.52 × 10¹²/L, Hb 130 g/L; platelets 119.0 × 10⁹/L; random blood glucose 8 mmol/L. Arterial blood gas analysis showed pH 7.46, pCO₂ 25 mmHg. No abdominal pain, diarrhea, vomiting, or bloody stools; no cough or hemoptysis. Preliminary diagnosis was acute anthrax (sepsis) complicated by anthrax meningitis. Treatment was initiated with penicillin G 8 million units and imipenem 500 mg, each administered four times daily, along with moxifloxacin 0.4 g once daily. On the first day of hospitalization… On the third day, the patient began experiencing dyspnea and frequent seizures and was intubated. On the fourth day of hospitalization, the patient’s blood pressure suddenly rose, heart rate and respiratory rate increased, and SpO2 dropped to 74%. Despite resuscitation efforts, the patient died in the early morning of the fifth day after admission. According to the laboratory report from the Ili Prefecture Center for Disease Control and Prevention, microscopic examination of the ulcer exudate revealed numerous large, Gram-positive bacilli arranged in chains.

2.2 Basic Information and Clinical Course The case resides in a remote, mountainous Kazakh village with poor transportation access. The population is approximately 400, living in a scattered settlement, all of whom are pastoralists. During the summer, they graze their livestock on pastures; in winter, they move to enclosures for cattle and sheep. Sanitary conditions are substandard, and the community is economically and culturally underdeveloped. Local herders have the harmful practice of slaughtering and consuming sick animals. The village has one village health worker, but medical care remains difficult to access. Through field investigations, it was determined that the patient had not traveled outside the area in the past three months. Two weeks earlier, the patient slaughtered and consumed a diseased cow exhibiting symptoms including inability to stand, generalized tremors, rapid breathing, and the discharge of a small amount of blood‑tinged fluid from natural orifices. One week after slaughtering the sick cow, the patient developed papules and vesicles on the fourth finger of the left hand, the dorsum of the hand, and the anterior forearm of the left upper limb; these lesions subsequently ulcerated and formed eschars. Despite seeking care at the village clinic, the township health center, and the county hospital, no definitive diagnosis was established. As the condition progressively worsened, the patient developed extensive edema of the left forearm, accompanied by headache, fever, altered consciousness, and eventually coma, prompting transfer to a tertiary‑level hospital at the prefectural level for further management.

2.3 Epidemiological Characteristics

2. 3. 1 Human Epidemic The locality is a natural focus of anthrax. However, no cutaneous anthrax cases have been reported or documented in the past three years. Case-finding identified an additional three individuals in the village who met the case definition; all were male, aged 23 to 46 years, yielding a case rate of 1.39% (4/287). Two cases presented with a solitary, relatively firm nodule on the lateral aspect of the left wrist, with mild pain and a scab that had already fallen off; one case exhibited a central black eschar at the base of the right ring finger, accompanied by surrounding tissue swelling, mild pruritus, and minimal pain. None of these three individuals had any contact with the fatal case. Prior to identification through active surveillance, they had all self‑treated with erythromycin ointment prescribed by the village health worker. There was no epidemiological link among these three cases or between them and the fatal case; therefore, the outbreak was classified as sporadic, with no evidence of clustering.

2. 3. 2 Inter-species Epidemic Situation From January 2015 to November 2015, the village reported the successive deaths of six cattle, fifteen sheep, and two dogs due to illness. Neighboring villages have also experienced livestock mortality, and during the summer, animals from both villages were grazed on the same pasture. All deceased cattle and sheep in this village were slaughtered; most of the meat was consumed by the households themselves, while some—along with the hides and wool—was sold. Only a very small portion of the offal (viscera) was discarded or fed to dogs, with no deep burial or incineration taking place. The meat and hides that were sold can no longer be traced. Neither the township nor the village veterinarians have identified the causes of these animal deaths, and there is no available data on recent outbreaks among livestock.

2. 3. 3 Close Contacts Since November 21, 2015, all 21 close contacts have been placed under home quarantine for 14 days, while the five individuals who participated in the handling of the patient’s remains have been subject to 14-day home medical observation starting November 26, 2015. No abnormalities were reported among any of the quarantined individuals, and the last group was released from isolation on December 10, 2015.

2.4 Cadaver Disposal In accordance with the national guidelines for the handling of anthrax fatalities, the body must be thoroughly disinfected; bed linens should be soaked in a chlorine‑based disinfectant, wrapped, and then sealed in a body bag. Items used by the patient must be disinfected or incinerated, followed by terminal disinfection. In view of the small number… In accordance with local customs, the deceased is not cremated but is transported directly to the burial site in an ambulance by trained personnel for deep burial. The body is interred in a composite structure consisting of alternating layers of soil and quicklime; the area surrounding the grave is disinfected by spraying with a chlorine‑based disinfectant. All individuals who have direct contact with the body during the funeral wear disposable masks and rubber gloves, and following burial, terminal disinfection is carried out on all attendees, the venue, and any vehicles involved.

2.5 Specimen Testing Testing revealed a weakly positive result for anthrax nucleic acid in the patient’s serum; due to the patient’s death, no convalescent‑phase serum was available for testing; bacterial isolation and culture did not yield Bacillus anthracis; microscopic examination of secretions identified numerous large, Gram‑positive bacilli arranged in chains.

2.6 Other Countermeasures Report the outbreak to the local animal husbandry and veterinary authorities, request a thorough investigation for anthrax among livestock, and implement effective measures to prevent its transmission to humans. Provide training on anthrax prevention and control to medical staff at the township health center to enhance their clinical management capabilities, and conduct public health education campaigns on anthrax prevention and control for local farmers and herders.