Epidemiology:

• Highly infectious after aerosolization
• Person-to-person and animal-to-human transmission can occur with pneumonic plague via respiratory droplet

Clinical:

• Incubation period is 1-3 days (ranges up to 7 days)
• Aerosolization would most likely result in pneumonic plague
• Pneumonic plague presents with acute onset of high fevers, chills, headache, malaise and a productive cough, that is initially watery before becoming bloody

Laboratory Diagnosis:

• Bacterial cultures (blood, sputum, or lymph node aspirate specimens) should be handled in a bio-safety level 2 facility
• Wright, giemsa, or wayson stain show gram negative coccobacilli with bipolar "saftety-pin" appearance
• Organism grows slowly (48 hrs for observable growth) on standard blood and macconkey agar
• Immunoflourescent staining for capsule (f1 antigen) is diagnostic

Patient Isolation:

• Strict respiratory isolation with droplet precautions (gown, gloves, and eye protection) until the patient has received at least 48 hours of antibiotic therapy and shows clinical improvement

Treatment:

• Streptomycin (1 g im bid) or gentamicin (5 mg/kg im or iv qd) are the referred antibiotics
• Tetracyclines or flouroquinolones are alternative choices
• Co-trimoxazole is recommended for pregnant women and children between the ages of 2 months and 8 years
• Chloramphenicol should be used for plague meningitis

Prophylaxis:

• Antibiotic prophylaxis is recommended for all persons exposed to the aerosol or persons in close physical contact with confirmed case
• Tetracyclines or flouroquinolones are recommended for 7 days from last exposure to a case