Pediatric Plague Follow-up

Updated: Jan 18, 2016
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
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Follow-up

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.

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Further Inpatient Care

Admit patients with plague for antibiotic therapy and isolation.

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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.

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Transfer

Transfer may be required for further hemodynamic and respiratory monitoring and isolation.

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Deterrence/Prevention

Plague continues to pose a threat to humans. [24] 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.

Patients with plague pneumonia should be placed in airborne precautions.

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.

A number of vaccines are currently under development, including live-attenuated, DNA, and subunit vaccines. A recent review details the new approaches to live-attenuated plague vaccines through construction of attenuated Y pestis strains with specifically defined mutations. [25] Traditionally, live-attenuated plague vaccines have been developed by multiple passages of fully virulent Y pestis. These vaccines raise safety concerns and are not recommended for the general population in the United States.

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Complications

Complications include the following:

  • Polyarthritis

  • Lung abscesses

  • Suppuration or superinfection of buboes

  • Meningitis

  • Death

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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.

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