Sunday, December 21, 2014
     

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