Woolsorter's disease

The name comes from the occupational exposure of workers handling infected animal products. Inhaled spores are carried by alveolar macrophages to mediastinal lymph nodes, where they germinate and release the tripartite anthrax toxin: protective antigen mediates entry, edema factor is a calmodulin-dependent adenylate cyclase producing massive oedema, and lethal factor is a zinc metalloprotease that cleaves MAP kinase kinase. The result is haemorrhagic mediastinitis and haemorrhagic thoracic lymphadenitis with pleural effusions; a widened mediastinum without lobar consolidation is the classic imaging finding. Illness begins as a nonspecific flu-like prodrome and then abruptly deteriorates into shock, often with haemorrhagic meningitis. Notably, inhalational anthrax does not cause a typical bronchopneumonia. B. anthracis is a gram-positive, spore-forming rod with a unique poly-D-glutamate capsule and a characteristic serpentine 'medusa head' colony morphology. Ciprofloxacin or doxycycline is used for treatment and post-exposure prophylaxis, and the organism is a category A bioterrorism agent.