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Plague



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

 

Clinical
  • Incubation period is 1-3 days and 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 Biosafety Level 2 facility.
  • Wright, Giemsa, or Wayson stain shows gram negative coccobacilli with bipolar “safety-pin” appearance.
  • Organism grows slowly (48 hrs for observable growth) on standard blood and Mac-Conkey 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 preferred 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 a confirmed case.
  • Tetracyclines or flouroquinolones are recommended for 7 days from last exposure to a case.
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