eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Plague: Follow-up
Updated: Nov 24, 2008
Follow-up
Further Inpatient Care
- Admit patients with plague for antibiotic therapy and isolation.
Further Outpatient Care
- Patient may be discharged on oral tetracycline or doxycycline after 48 hours if hemodynamically stable and symptoms are resolving.
- Follow up closely for potential relapse.
Inpatient & Outpatient Medications
- Antibiotics include streptomycin, tetracycline, doxycycline, and chloramphenicol. Y pestis is often susceptible in vitro to ampicillin, but this antibiotic is rarely effective in vivo. Gentamicin is equally as effective as streptomycin. Antipyretics are useful for patient comfort.
Transfer
- Transfer may be required for further hemodynamic and respiratory monitoring and isolation.
Deterrence/Prevention
- Identifying the source of infection is vital in preventing outbreaks. If an urban area is involved, rodent control should be undertaken. In rural plague-endemic areas, the public must be instructed to avoid handling sick or dead animals and to avoid places where wild animals live. Pets should be kept free of fleas.
- Contacts of pneumonic plague victims should receive antibiotic prophylaxis. Ciprofloxacin or doxycycline is typically used. Trimethoprim-sulfamethoxazole has also been effective for prophylaxis. Contacts of those with bubonic or septicemic plague have no need for prophylaxis.
- Plague vaccine is no longer available in the United States.
Complications
- Polyarthritis
- Lung abscesses
- Suppuration or superinfection of buboes
- Meningitis
- Death
Prognosis
- Mortality rate for untreated plague is 40-70%.
- Untreated pneumonic plague is nearly 100% fatal.
- From 1947-1996, reported mortality rate in the United States was 15%.
- Because plague is often a difficult disease to consider in the differential diagnosis, many patients who succumb to it have previously sought medical care.
Miscellaneous
Medicolegal Pitfalls
- Failure to consider plague in the differential diagnosis
- Failure to take adequate precautions in patients with pneumonic plague against transmission to others
- Failure to differentiate septicemic plague from gram-negative bacterial sepsis
Special Concerns
- Disease reporting
- By law, cases of suspected plague must be reported to the state or local health department. The health department then alerts the Centers for Disease Control and Prevention (CDC). Both organizations investigate all suspected cases.
- Confirmed cases are reported to the WHO.
- Bioterrorism
- Y pestis has been used as a bioweapon, notably by the Japanese during World War II. In addition, in the midst of the Cold War, the former Soviet Union weaponized the plague bacillus. Today, the use of plague as a biological weapon has clear advantages for terrorists.
- Plague is endemic in many parts of the world and is easily found in nature. Only a small inoculum of fewer than 500 organisms needs to be inhaled to result in pneumonic plague, which is then very contagious to individuals within a 2-m radius. Mortality is high if patients are not treated rapidly. The 3-4 day incubation period, coupled with modern transportation systems, allows for swift widespread expansion of disease. Initial symptoms are clinically indistinguishable from various common illnesses, especially during the winter season.
- A high index of suspicion is required to discern plague from community-acquired pneumonia or numerous viral illnesses.
More on Plague |
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| Differential Diagnoses & Workup: Plague |
| Treatment & Medication: Plague |
 Follow-up: Plague |
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References
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Further Reading
Keywords
plague, black death, black plague, bubonic plague, septicemic plague, pneumonic plague, ambulant plague, Yersinia pestis, bioterrorist agent, bioterrorism, bacteremia, pneumonia, septicemia, meningitis, polyarthritis, lung abscess, pharyngitis
