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