These symptoms usually persist for 2-3 days, and may even be followed by a short period of improvement. The terminal symptoms appear suddenly and include increasing respiratory distress with difficulty breathing, stridor, cyanosis, increased chest pain, and diaphoresis. The most critical aspect of making the diagnosis of inhalation anthrax is having a high index of suspicion, since the early symptoms are entirely nonspecific. The clinical picture of respiratory distress is helpful, especially in association with CXR evidence of a widened mediastinum, a result of the edema and hemorrhage occurring in the tracheobronchial lymph nodes. Sputum stains and cultures are not helpful in diagnosis since this is a mediastinal disease and not a pneumonia.
Blood cultures are positive late in the course of the illness.
Historically, penicillin was the treatment of choice for anthrax. However, in the absence of information concerning antibiotic sensitivity, the current recommended treatment is ciprofloxacin 400 mg IV every 8-12 hours or doxycycline 200 mg IV followed by 100 mg IV every 12 hours, along with supportive treatment in an intensive care environment. Antibiotics are also used as post-exposure treatment within 24 hours and before onset of symptoms to protect asymptomatic persons after exposure to aerosolized anthrax spores. If an anthrax exposure is detected, and confirmed, oral antibiotic treatment should be initiated immediately using ciprofloxacin 500 mg orally twice a day, or doxycycline 100 mg orally twice a day for at least 30 days. These exposed, asymptomatic individuals must also receive at least the first 3 doses of anthrax vaccine.