Question
Wool sorter’s disease.
Answer
Wool sorter’s disease is the term for pulmonary (inhalational) anthrax, caused by inhaling spores of Bacillus anthracis — historically an occupational disease of workers handling contaminated wool, hides, and animal hair (spores contaminating these materials become airborne during sorting/processing).
Pathogenesis: inhaled spores are taken up by alveolar macrophages, carried to mediastinal lymph nodes, where they germinate into vegetative bacilli; the organism produces a tripartite exotoxin (protective antigen, oedema factor, lethal factor) causing severe haemorrhagic mediastinitis, massive lymphadenopathy, and rapidly progressive haemorrhagic pneumonia — untreated, it is almost universally fatal, often within days, due to toxaemia, respiratory failure, and septicaemic spread with meningitis.
Clinical features: initial non-specific flu-like symptoms, followed by abrupt deterioration with high fever, dyspnoea, stridor, and a characteristic widened mediastinum on chest X-ray.
Diagnosis: Gram stain/culture (large, Gram-positive, spore-forming, box-car shaped bacilli, non-haemolytic on blood agar, “Medusa head” colonies) from blood/sputum; PCR; serology.
Prevention: occupational hygiene and protective equipment for high-risk workers, disinfection/sterilization of animal products (wool, hides) before processing, anthrax vaccination for at-risk personnel, and prompt antibiotic prophylaxis (ciprofloxacin/doxycycline) after known exposure.