PLAGUE / MedUrgent

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 PLAGUE

Plague is a zoonotic infection of rodents which is caused by the gram negative coccobacillus Yersinia pestis. The disease is transmitted by fleas that feed on rats or through direct contact with infected tissues and body fluids. Incubation period is 2-8 days.

Pathogenesis: After a flea bite or exposure through other methods, the bacteria migrate to the lymph nodes leading to lymphadenopathy (Buboes) and it may spread systemically leading to bacteremia or pneumonia. Clinical picture: Plague may present in any of the following forms:

1- Bubonic: This is the commonest form. Two to eight days after a flea bite, the inguinal lymph nodes enlarge and may be associated with fever, rigors, headache and prostration. Other lymph nodes e.g. axillary and cervical may also be involved. DIC, purpura, gangrene and death may soon follow.

2- Septicemia: This form may follow bubonic plague or results from direct contact with infected fluids and tissues. It presents with severe toxicity, hypotension, acute respiratory distress and DIC.

3- Pneumonic: Acquired by droplet inhalation or secondary to haematogenous spread of the bacteria. It leads to pneumonia, cough, fever, dyspnea and hemoptysis.

4. Meningeal: Clinical evidences of meningeal involvement with rigidity and hyperreflexia is a rare presentation.







Diagnosis

-Gram stain of lymph node aspirate or body fluids to identify Y. pestis -Culture of lymph node aspirate or body fluids

-Fluorescent Antibody Test

-Haemagglutination Test 

-Sero-coversion of antibody titer

Treatment

- Isolation.

- Streptomycin, chloramphenicol, gentamycin or tetracycline (for adults) may be used.

- Contacts should have prophylactic doses of tetracycline (adults) or cotrimoxazole for seven days and start the vaccine (inactivated bacteria given in three doses 1-3 months apart).

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