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

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