Plague pneumonic

As with anthrax, early diagnosis of plague is critical and requires a high index of suspicion. In the United States, if only a small number of cases occur, physicians may overlook pneumonic plague for a couple of reasons. First, plague pneumonia 

Epidemiology Incubation period Clinical signs studies Pathology 

Sudden appear- 1-7 days, usually Acute onset of Pulmonary Lobular exuda- 

Patients have ful- skin lesions bipolar (safety  

Source Reprinted with permission from Inglesby et al. (4) Plague as a biological weapon medical and public health management. JAMA May 2000 283(17) 2281-2290. Copyright 2000 American Medical Association. All rights reserved. 

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Suggested Alternatives for Differential Diagnosis Drug induced noncardiac pulmonary edema, acute respiratory distress syndrome, pneumonic plague, tularemia, Q fever, and viral influenza. 

Pneumoencephalitis Pneumonic Plague Pneumonomycosis Pneumorickettsiosis PnIB... 

Decontamination Soap and water, or diluted sodium hypochlorite solution (0.5 percent). Removal of potentially contaminated clothing should be done by people in full protective clothing in an area away from non-contaminated persons. For victims with bubonic plague, drainage, and secretion procedures need to be employed. Careful treatment of buboes is required to avoid aerosolizing infectious material. For victims with pneumonic plague, strict isolation is absolutely necessary. Heat, disinfectants and sunlight renders bacteria harmless. 

Primary pneumonic plague occurs after inhalation of organisms, which may occur by aerosol transmission from a person or animal with secondary or primary pneumonic plague. Septicemic plague may evolve from any form of plague. It features the acute onset of bacteremia, septic shock, and thrombosis with or without antecedent lymphadenitis. Prognosis for both pneumonic and septicemic pneumonic plague is poor the fatality rate is 100 percent for untreated cases. 

Caution The death rate from untreated pneumonic plague can reach almost 100 percent. Once a human is infected with plague, a progressive and potentially deadly illness usually results unless antibody therapy is administered. In a progressional sequence, the patient develops blood infection which leads to lung infection. 

Prophylaxis For asymptomatic patients exposed to plague aerosol, or to a patient with suspected pneumonic plague, provide doxycycline at 100 mg orally twice daily for seven days, or for the duration of risk of exposure plus one week. Alternative antibiotics include ciprofloxacin, tetracycline, or chloramphenicol. No vaccine is currently available for plague propylaxis. The previously available licensed, killed vaccine was effective against bubonic plague, but not against aerosol exposure. 

Isolation Precautions for Pneumonic Plague Standard precautions for all aspect of care including droplet precautions and strict hand washing with antimicrobial soap. 

Patient Placement for Pneumonic Plague Private room or share with like patients if no private rooms are available. 

Patient Transport with Pneumonic Plague Limit movement, essential purposes only mask patient before transport. 

Cleaning, Disinfecting Equipment with Pneumonic Plague (The same series of isolation controls as for bubonic plague). 

Discharge Management with Pneumonic Plague Teach care givers Standard Precautions do not discharge until no longer infectious do not discharge until after seventy-two hours of antibiotics. 

Post-Mortem Care with Pneumonic Plague Follow Standard Precautions droplet precautions and disinfect surfaces with 1 9 bleach/water solution (10 percent). 

Plague. Clinical features of pneumonic plague include fever, cough with muco-purulent sputum (gram-negative rods may be seen on gram stain), hemoptysis, and chest pain. A chest radiograph will show evidence of bronchopneumonia. 

Pneumonic plague is one of several forms of plague. Depending on circumstances, these forms may occur separately or in combination ... 

With pneumonic plague, the first signs of illness are fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. The pneumonia progresses for 2 to 4 days and may cause respiratory failure and shock. Without early treatment, patients may die. 

Early treatment of pneumonic plague is essential. To reduce the chance of death, antibiotics must be given within 24 hours of first symptoms. Streptomycin, gentamicin, the tetracyclines, and chloramphenicol are all effective against pneumonic plague. 

Pneumonic) Plague 1. Aerosol 2. Infected vectors High High 2-3 days 1-2 days Very high Less important because of high transmissibility Yes Moderately effective No... 

Plague Bacterial agent that may cause bubonic plague or pneumonic plague. 

Variations of disease Bubonic plague, pneumonic plague... 

In a biological warfare scenario, the plague bacteria could be delivered by contaminated fleas (bubonic plague) or, more likely, by aerosol spread (pneumonic plague). Pneumonic plague can be transmitted also by large aerosol droplets expelled by coughing. 

Plague is caused by Yersinia pestis, bacteria that are carried through infected flea bites, direct contact, and by inhalation of infective materials. Bubonic plague is the most common form of plague and is derived from the bite of a flea that fed previously on infected animals. Pneumonic plague causes the greatest amount of mortality and is transmitted by aerosol. It... 

Vaccines need to be developed against diseases with high mortality rates, such as AIDS, pneumonic plague, acute respiratory infections, diarrhea, and parasitic diseases such as malaria. 

The historical antibiotic of choice for the treatment of plague has been streptomycin. Gentamicin is another preferred antibiotic. Alternative regimens include doxycycline, ciprofloxacin, and chloramphenicol. Patients with pneumonic plague may also require advanced medical supportive therapy in addition to antibiotics. 

Elvin, S. J., Eyles, J. E., Howard, K. A., Ravichandran, E., So-mavarappu, S., Alpar, H. 0., et al. (2005). Protection against bubonic and pneumonic plague with a single dose microencapsulated sub-unit vaccine. Vaccine, 24(20), 4433-4439. 

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