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Yersinia pestisAka: Pneumonic Plague, Bubonic Plague, Plague

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  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

Plague (C0032064)

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.
ConceptsDisease or Syndrome (T047)
ICD9020, 020.9
EnglishInfection by Yersinia pestis, Pest, Pestilential fever, Plague, Plague unspecified, Yersinia pestis disease
Spanishinfección por Yersinia pestis, infeccion por Yersinia pestis, peste, peste no especificada
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Bubonic Plague (C0282312)

ConceptsDisease or Syndrome (T047)
ICD9020.0
EnglishBlack death, Bubonic plague, PESTIS BUBONICA, PESTIS FULMINANS
Spanishpeste bubónica, peste bubonica, peste fulminante, peste glandular, peste mayor
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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