Although most physicians in industrialized countries have never seen a case of anthrax, the potential use of spores of Bacillus anthracis in biological warfare makes basic knowledge of the presentation and treatment of this ancient disease important. The primary threat concerns dispersal of aerosolized anthrax spores in a densely populated area, potentially causing tens of thousands of casualties. Symptoms from inhalational anthrax begin 1 to 6 days after exposure, with nonspecific manifestations such as dry cough, mild fever, myalgias, and malaise. The patient often recovers from this initial phase, only to present several days later with severe respiratory distress and shock, which rapidly and almost inevitably causes death. Chest radiograph during the preterminal stage may show widened mediastinum and pleural effusions.
Meningitis occurs in as many as half the cases.
Although the drugs of choice for natural anthrax include high-dose penicillin, ciprofloxacin, and doxycycline, strains manufactured for biological warfare may have been altered for resistance to standard antibiotics. The existing vaccine has not been tested for efficacy in humans, but has been shown to protect rhesus monkeys against inhalational anthrax after 2 doses. Well-fitting M17 or M40 gas masks provide respiratory protection from exposure. Postexposure treatment involves prolonged administration of antibiotics and concomitant vaccination. Identifying an outbreak early is the key to initiating life-saving treatment, and emergency personnel will be key players in surveillance for clusters of cases.