For skin infection, itching of the exposed area occurs first, followed by a lesion that develops into a depressed black scar that is usually surrounded by extensive reddened swelling of the skin. Initial symptoms of a lung infection include fever, aches, fatigue, nonproductive cough and mild chest discomfort. These symptoms are followed by a short period of improvement, followed by the sudden development of severe respiratory distress with difficulty breathing, shortness of breath, sweating, and bluish discoloration of the lips and extremities. Shock and death usually follow within 24-36 hours. Symptoms of intestinal anthrax are abdominal distress and fever. This rapidly progresses to an infection of the bloodstream usually followed by death.