Plague

Signs and Symptoms

Pneumonic plague begins after an incubation period of 1-6 days, with high fever, chills, headache, malaise, followed by cough (often with blood), progressing rapidly to labored, raspy breathing, cyanosis, and death. Gastrointestinal symptoms are often present.

Death results from respiratory failure, circulatory collapse, and internal bleeding. Bubonic plague, featuring high fever, malaise, and painful lymph nodes (buboes) may progress spontaneously to a severe bacterial infection (septic shock, thrombosis) or to pneumonia.

Diagnosis

Suspect plague if large numbers of previously healthy individuals suddenly develop pneumonia, especially if bloody mucus is present. Presumptive diagnosis can be made by Gram, Wright, Giemsa or Wayson stain of blood, sputum, or lymph node aspirates. Definitive diagnosis requires culture of the organism from those sites. Immunodiagnosis is also helpful.

Treatment

Early administration of antibiotics is critical, as pneumonic plague is invariably fatal if antibiotic therapy is delayed more than 1 day after the onset of symptoms. Use one of the following, for 10-14 days:

Chloramphenicol is the drug of choice for plague meningitis.

Preventative Measures

For asymptomatic persons exposed to a plague aerosol or to a patient with suspected pneumonic plague, give doxycycline 100 mg orally twice daily for seven days or the duration of risk of exposure plus one week.

Alternative antibiotics include ciprofloxacin, tetracycline, or chloramphenicol. No vaccine is currently available for plague prevention.