Chest 1999 Nov;116(5):1369-76
Inhalational anthrax: epidemiology, diagnosis, and management.
Shafazand S, Doyle R, Ruoss S, Weinacker A, Raffin TA.
Anthrax, a disease of great historical interest, is once again making
headlines as an agent of biological warfare. Bacillus anthracis, a rod-shaped,
spore-forming bacterium, primarily infects herbivores. Humans can acquire
anthrax by agricultural or industrial exposure to infected animals or animal
products. More recently, the potential for intentional release of anthrax spores
in the environment has caused much concern. The common clinical manifestations
of anthrax are cutaneous disease, pulmonary disease from inhalation of anthrax
spores, and GI disease. The course of inhalational anthrax is dramatic, from the
insidious onset of nonspecific influenza-like symptoms to severe dyspnea,
hypotension, and hemorrhage within days of exposure. A rapid decline,
culminating in septic shock, respiratory distress, and death within 24 h is not
uncommon. The high mortality seen in inhalational anthrax is in part due to
delays in diagnosis. Classic findings on the chest radiograph include widening
of the mediastinum as well as pleural effusions. Pneumonia is less common; key
pathologic manifestations include severe hemorrhagic mediastinitis, diffuse
hemorrhagic lymphadenitis, and edema. Diagnosis requires a high index of
suspicion. Treatment involves supportive care in an intensive care facility and
high doses of penicillin. Resistance to third-generation cephalosporins has been
noted. Vaccines are currently available and have been shown to be effective
against aerosolized exposure in animal studies.
