In inhalational anthrax, finding is:

Ans: b (mediastinal widening and pleural effusion) Ref: Davidson 20th ed/p.333.This is a direct pick from Davidson.Three forms of infection with Bacillus anthracis:-i) Cutaneous anthrax* Skin lesion due to occupational exposure to anthrax spores or bioterrorism.* Spores inoculated into exposed skin single lesion, an irritated papule on oedematous haemorrhagic base depressed black eschar. Pain infrequent.ii) Gastrointestinal anthrax* Ingestion of contaminated meat products* Caecum is the seat of infection* C/F - nausea, vomiting, anorexia, fever. Later severe abdominal pain and bloody diarrhoea. Toxaemia and death thereafter.iii) Inhalational anthrax* Rare. Associated with bioterrori sm.* Great mortality* C/F - fever, dyspnoea, cough, headache. Later on septicaemia.* CXR- mediastinal widening and pleural effusion.Investigation: Culture from Skin swabs.Management:Ciprofloxacin 500mg daily until penicillin susceptibility confirmed.Benzylpenicillin 600 000units i.m. 6 hourly.Aggressive fluid resuscitation. Ventilatory assistance in inhalational anthrax.Prophylaxis:Ciprofloxacin 500mg 12hourly for high risk from exposure.