Plague: Difference between revisions
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Revision as of 12:09, 5 June 2016
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
- Usually in axilla or groin
- Liver and splenic involvement
- Septicemia
- Death if untreated in 2-10 days
Pulmonic plague
- Very contagious
- Can be hematogenous or aerosolized (weapon form)
- 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
Bioterrorism Agents[1]
Category A
Category B
- Ricin
- Brucellosis
- Epsilon toxin
- Psittacosis
- Q Fever
- Staph enterotoxin B
- Typhus
- Glanders
- Melioidosis
- Food safety threats
- Water safety threats
- Viral encephalitis
Category C
- Influenza
- Yellow fever
- Tickborne hemorrhagic fever
- Tickborne encephalitis
Diagnosis
Management
Droplet precautions if pneumonic form suspected
- Plague is a reportable disease to the CDC
- If bioterrorism suspected, health authorities must be contacted immediately
Antibiotics
Postexposure Prophylaxis
- Doxycycline 100mg (2.2mg/kg) PO q12hrs daily OR
- Ciprofloxacin 500mg (20mg/kg) PO q12hrs daily OR
- Chloramphenicol 1mg (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
Disposition
- Admit
- Droplet precautions if pneumonic form suspected