Plague
Background
- The plague is a severe, acute infection caused by Gram Negative bacillus, Yersinia pestis.
- Two main forms are bubonic and pulmonic forms
- Considered a Class A bioterrorism agent
Clinical Features
Bubonic plague
- Eschar often forms at site of vector bite (usually flea bite)
- Buboes (inflamed, necrotic or hemorrhagic lymph nodes) are pathognomonic
- Liver and splenic involvement
- Septicemia
- Death if untreated in 2-10 days
Pulmonic plague
- Hemoptysis
- Mulilobar hemorrhagic pneumonia
- Sepsis
- Death if untreated in 48 hours
Differential Diagnosis
Lower Respiratory Zoonotic Infections
- Psittacosis
- Anthrax (Bacillus anthracis)
- Brucellosis (Brucella species)
- Q fever (C. burnetti)
- Pasteurellosis (Pasteurella multocida)
- Melioidosis (Burkholderia pseudomallei)
- Rocky Mountain Spotted Fever (R. rickettsii)
- Pulmonic Plague (Yersinia pestis)
- Influenza A
- Hantavirus
Management
- Droplet precautions if Pneumonic form suspected
- Treatment should be started within 24 hours of symptoms one of these antibiotics:
Antibiotics
Postexposure Prophylaxis
- Doxycycline 100mg (2.2mg/kg) PO q12hrs OR
- Ciprofloxacin 500mg (20mg/kg) PO q12hrs OR
- Chloramphenicol 25mg/kg PO q6hrs
- only if age > 2
Active Disease
- Gentamicin 5mg/kg IV/IM once daily x 10 days OR
- Ciprofloxacin 500mg (20mg/kg) PO q12hrs x 10 days OR
- Doxycycline 200mg (2.2mg/kg) PO/IV daily
- Streptomycin 1g IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)
- Streptomycin 15mg/kg IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)
Pediatric
- Gentamicin 2.5mg/kg IV/IM q8hrs x 10 days
- Doxycycline 2.2mg/kg PO/IV q12hrs (max 100mg/dose)
- Ciprofloxacin 15mg/kg PO q12hrs (max 500mg/dose)
- Chloramphenicol 25mg/kg PO/IV q6hrs (max 4g/day); age >2 only
Disposition
- Plague is a reportable disease to the CDC
- If bioterrorism suspected, health authorities must be contacted immediately
See Also
Sources
Tintinalli