RISK FACTORS: Exposure to rats and fleas, Close contact with infected cat, Close contact with pneumonic plague patient, Plague bacillus in laboratory, Hunters who skin wild animals, Potential agent of bioterrorism, Occupational risk: field workers
APPROPRIATE HEALTH CARE
β’ Hospitalization. For suspected pneumonic plague, respiratory isolation until 48 hours after initial effective
therapy or after sputum negative.
β’ Notify public health authorities
GENERAL MEASURES
β’ Do not create aerosol
β’ Handle blood and bubo aspirate with gloves
β’ Notify laboratory to take precautions
β’ Intravenous fl uids as required
β’ Hot, moist compresses for buboes
ACTIVITY Bedrest until convalescent
DIET As tolerated during recovery
PATIENT EDUCATION
β’ Avoid contact with wild animals
β’ Reduce rat and flea population in environment
DRUG(S) OF CHOICE
β’ Aminoglycoside (gentamicin 5.1 mg/kg/day or streptomycin 15 mg/kg)
β’ If condition allows oral medication: tetracycline 25-50 mg/kg/day, equally divided, every 6 hours for 10 days
β’ For meningitis: chloramphenicol 25 mg/kg followed by 60 mg/kg in 4 equally divided doses, daily for 10 days
β’ Fluoroquinolones (levofl oxacin, ofl oxacin) and third generation cephalosporins (cefotaxime) may also be
effective
PATIENT MONITORING
β’ CBC for hematologic toxicity of chloramphenicol
β’ Aminoglycoside blood levels if indicated
β’ Clinical testing for antibiotic toxicity if indicated
PREVENTION/AVOIDANCE
β’ Avoid contact with vectors, infected tissue or aerosol, e.g., pneumonic plague case
β’ Killed vaccine for people at high risk to reduce risk and/or severity; tetracycline prophylaxis. Vaccine available from C.D.C., Atlanta.
POSSIBLE COMPLICATIONS
β’ Progression of bubonic form to septicemic and pneumonic forms
β’ Necrosis of bubo may require aspiration or incision and drainage
β’ Pericarditis
β’ Adult respiratory distress syndrome
β’ Meningitis
β’ Death
EXPECTED COURSE/PROGNOSIS
β’ Untreated plague mortality > 50%; 100% in primary pneumonic plague
β’ Plague may be fulminant, e.g., exposure, first symptoms and death in one day in primary pneumonic plague. Must not delay treatment of suspected cases until laboratory-confi rmed diagnosis. Delay of initial therapy beyond 24 hours after onset of primary pneumonic plague regularly followed by death.