Modern Nightmare: Inhalational Anthrax In The Emergency Department

Abstract

The serious forms of human anthrax are inhalational, cutaneous and intestinal anthrax. Anthrax remains an occupational disease of herdsmen and workers who have direct contact with infected animals or who process animal products, especially wool, and is still a significant problem in developing parts of the world. Patients usually have a work history of exposure to contaminated animal products, most often animal hair and wool used in the textile industry. The clinical course of inhalational anthrax is almost always dramatic, from the insidious onset of nonspecific influenza-like symptoms to severe dyspnea, hypotension, and hemorrhage within days of exposure. The classic clinical presentation of inhalational anthrax was described as a 2-stage illness. Patients first develop nonspecific symptoms, including fever, dyspnea, cough, headache, vomiting, chills, weakness, abdominal pain, and chest pain. The second phase is manifested with fever, acute dyspnea, hypoxemia, acute respiratory distress, stridor, cyanosis and diaphoresis. This Iate stage is rapidly progressive, with shock, associated hypothermia, and death occurring within 24 to 36 hours. Obtundation and nuchal rigidity appear as a result of complicating anthrax meningitis in half of the patients. Diagnosis requires a high index of suspicion. A chest X-ray will demonstrate pleural effusions associated with widening of the mediastinum consistent with lymphadenopathy.