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Yersinia pestis

Aka: Yersinia pestis, Pneumonic Plague, Bubonic Plague, Plague
  1. Cause: Plague
    1. Yersinia pestis
  2. Pathophysiology
    1. Gram Negative Rod
      1. Bipolar staining
      2. Facultative anaerobic bacterium
    2. Incubation
      1. Pneumonic Plague: 2-3 days
      2. Bubonic Plague: 2-10 days
    3. Organism survival
      1. Viability
        1. Water, moist meal, grain for weeks
        2. Near freezing temperatures from months to years
        3. Dry Sputum, flea feces, buried bodies
      2. Killed by
        1. Heated for 15 minutes at 72 C
        2. Several hours in direct sunlight
  3. Transmission
    1. Reservoir: Rodents (rats, mice, ground squirrels)
    2. Fleas transmit bubonic form
    3. Aerosolized organisms transmit pneumonic form
  4. Types of Plague
    1. Bubonic Plague
    2. Primary septicemic Plague
    3. Pneumonic Plague
  5. Symptoms and signs
    1. Pneumonic Plague
      1. High fever
      2. Chills
      3. Headache
      4. Hemoptysis
      5. Toxic appearance
    2. Bubonic Plague
      1. Malaise
      2. High fever
      3. Tender lymph nodes (buboes)
        1. Primarily inguinal (legs most commonly flea bitten)
  6. Management
    1. Treat for 10-14 days
    2. Streptomycin
      1. Adult: 30 mg/kg/day divided q12 hours IM
      2. Child: 15 mg/kg (up to 2 g) IM q12 hours
    3. Gentamicin
      1. Adult: 5 mg/kg IM or IV qd
      2. Child: 2.5 mg/kg IM or IV q8 hours
    4. Doxycycline (over age 8 years)
      1. Convert to PO dosing when clinically improved
      2. Adult: 200 mg IV, then 100 mg IV q12 hours
      3. Child: 2.2 mg/kg IV q12 hours
        1. Dose as adult for children over 45 kg
    5. Ciprofloxacin (adults only)
      1. Initial: 400 mg IV q12 hours
      2. When improved: 750 mg PO bid
  7. Prevention
    1. Licensed, killed vaccine (no longer available)
      1. Doses at 0, 1-3 months, and 5-6 months
      2. Booster at 6 month intervals x3, then every 1-2 years
      3. Effective against bubonic, but not pulmonic Plague
    2. Post-exposure prophylaxis (adult dosing below)
      1. Continue for 7 days or length of exposure
      2. Doxycycline 100 mg PO bid
      3. Ciprofloxacin 500 mg PO bid
      4. Tetracycline 500 mg PO qid
  8. Prognosis
    1. Mortality 100% if untreated
  9. References
    1. Inglesby (2000) JAMA 283:2281-90

Bubonic Plague (C0282312)

Concepts Disease or Syndrome (T047)
MSH D010930
ICD9 020.0
ICD10 A20.0
SnomedCT 50797007, 58750007
English BLACK DEATH, PESTIS BUBONICA, PESTIS FULMINANS, PLAGUE, BUBONIC, Plague, Bubonic, BUBONIC PLAGUE, black death, bubonic plague, bubonic plague (diagnosis), Bubonic Plague, black deaths, black plague, Black plague, Bubonic plague, Black death, Bubonic plague (disorder), bubonic; plague, plague; bubonic
Dutch zwarte pest, bubonen; pest, pest; bubonen, builenpest, Builenpest
French Peste noire, Peste bubonique
German schwarzer Tod, Bubonenpest, Beulenpest
Portuguese Peste negra, Peste Bubônica, Peste bubónica
Spanish Peste negra, Peste Bubónica, Peste Bubonica, peste bubónica (trastorno), peste bubónica, peste fulminante, peste glandular, peste mayor, Peste bubónica
Japanese 腺ペスト, 黒死病, センペスト, コクシビョウ
Italian Peste bubbonica
Czech Bubonický mor, Černý mor
Korean 림프절형 페스트
Hungarian bubopestis, Fekete pestis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Plague (C0032064)

Definition (NCI) A Gram-negative bacterial infection caused by Yersinia pestis. It is usually transmitted to humans from bites of infected rodent fleas. It is manifested as a bubonic, septicemic, or pneumonic plague. In bubonic plague, the lymph nodes adjacent to the site of the skin bite are infected and enlarged. In septicemic plague, the infection spreads directly through the bloodstream. In pneumonic plague, the infection spreads to the lungs either following bubonic plague, or by inhalation of infective droplets. If untreated, it may lead to death.
Definition (CHV) an infectious disease
Definition (CHV) an infectious disease
Definition (CHV) an infectious disease
Definition (CHV) an infectious disease
Definition (MEDLINEPLUS)

Plague is an infection caused by the bacterium Yersinia pestis. The bacteria are found mainly in rats and in the fleas that feed on them. People and other animals can get plague from rat or flea bites. Historically, plague destroyed entire civilizations. In the 1300s, the "Black Death," as it was called, killed approximately one-third of Europe's population. Today plague is uncommon. This is largely due to better living conditions and antibiotics.

There are three forms of plague:

  • Bubonic, which causes the tonsils, adenoids, spleen and thymus to become inflamed. Symptoms include fever, aches, chills and tender lymph glands
  • Septicemic, in which bacteria multiply in the blood. It causes fever, chills, shock and bleeding under the skin or other organs
  • Pneumonic, in which the bacteria enter the lungs and cause pneumonia. People with the infection can spread this form to others. This type could be a bioterror agent

Treatment for plague is a strong antibiotic. There is no vaccine for plague.

NIH: National Institute of Allergy and Infectious Diseases

Definition (MSH) An acute infectious disease caused by YERSINIA PESTIS that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form.
Definition (CSP) acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites; bubonic plague is the most common form.
Concepts Disease or Syndrome (T047)
MSH D010930
ICD9 020.9, 020
ICD10 A20, A20.9
SnomedCT 187298009, 186290009, 58750007
English Yersinia pestis disease, Plague, NOS, Plague unspecified, Plague, unspecified, Yersinia pestis plague (diagnosis), Yersinia pestis plague, plague, plague (diagnosis), Plague unspecified (disorder), Yersinia pestis infection, Unspecified plague, Plague NOS, Plague [Disease/Finding], pest, pestilential fever, plagues, Infection by Yersinia pestis, Pest, Pestilential fever, Plague (disorder), Pasteurella; infection, pestis, Yersinia pestis; infection, infection; Pasteurella, pestis, infection; Yersinia pestis, Plague
Dutch pest, niet-gespecificeerd, Yersinia pestis-infectie, niet-gespecificeerde pest, Pasteurella; infectie, pestis, Yersinia pestis; infectie, infectie; Pasteurella, pestis, infectie; Yersinia pestis, Pest, niet gespecificeerd, pest, Bubonenpest, Pest
French Infection à Yersinia pestis, Peste, non précisée, Peste non précisée, Peste
German Pest, unspezifisch, Yersinia pestis-Infektion, unspezifische Pest, Pest, nicht naeher bezeichnet, Pest
Italian Infezione da Yersinia pestis, Peste non specificata, Peste
Portuguese Peste NE, Infecção por Yersinia pestis, Peste
Spanish Infección por Yersinia pestis, Peste no especificada, Plague unspecified, infección por Yersinia pestis, peste (trastorno), peste no especificada (trastorno), peste no especificada, peste, Peste
Japanese 詳細不明のペスト, ペスト菌感染, ペスト、詳細不明, ペスト, ペストショウサイフメイ, ショウサイフメイノペスト, ペストキンカンセン, 腺ペスト, 黒死病, 黒死症, ペスト
Swedish Pest
Czech mor, Infekce Yersinia pestis, Blíže neurčený mor, Mor, Mor, blíže neurčený
Finnish Rutto
Russian CHUMA, ЧУМА
Korean 페스트, 상세불명의 페스트
Polish Dżuma, Zakażenie Yersinia pestis
Hungarian Pestis, nem meghatározott, Nem meghatározott pestis, Yersinia pestis fertőzés, pestis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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