Doctors differentiate inhalational anthrax early by looking at exposure history and subtle red flags, not just symptoms. While the initial fever, cough, and fatigue resemble the flu, anthrax often shows rapid worsening after a brief “mild” phase, unusually severe shortness of breath, chest discomfort, and marked widening of the chest (mediastinum) on imaging, which is uncommon in typical pneumonia or flu. It progresses so quickly because Bacillus anthracis releases potent toxins that disrupt immune responses, cause massive inflammation, and lead to fluid leakage, shock, and respiratory failure rather than just localized lung infection. This toxin-driven damage—rather than bacterial growth alone—is what makes inhalational anthrax escalate faster and become life-threatening if not treated very early.