Presently the mortality due to anthrax in England and other Eropean countries is seen in injecting drug (heroin) users.

This could be a source of infection if injected, smoked or snorted. The clinical presentation is likely to vary according to the way in which the heroin is taken and might include: Swelling and redness at an injection site, which may or may not be painful; abscess or ulcer at an injection site often with oedema; Septicaemia ; Meningitis; Symptoms of inhalational anthrax - flu-like illness - fever, headache, muscle aches and non-productive cough. Whereas anthrax is an “occupational” disease and these symptoms of anthrax can be further evaluated clinically/ lab work out in individuals with history of an occupational exposure to infected animals or their products, the present index cases are “atypical” presentations of anthrax in drug-abusers. Therefore a high degree of suspicion is essential to “spot” anthrax … I would add a clinical dictum  ...“it must be assumed that heroin or any drug abuser is a suspect of anthrax unless proved otherwise.”