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

1. Tularemia
2. Anthrax

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

1. Droplet precautions if pulmonic form suspected
2. Treatment should be started within 24 hours of symptoms one of these abx:
   1. Doxycyline 100mg PO/IV BID
   2. Ciprofloxacin
   3. Gentamicin 2mg/kg IV load then 1.7mg/kg TID x 10-14days

Disposition

• Plague is a reportable disease to the CDC
• If bioterrorism suspected, health authorities must be contacted immediately

See Also

• Isolation Precautions
• Bioterrorism
• GEMC:Prehospital / Disaster / Mass Casualty Medicine

Sources

Tintinalli