Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-B – PLAGUE ( YERSINIA PESTIS )

PLAGUE – QUICK REFERENCE

Bioterrorism Epidemiology: ? Pneumonic plague: most likely disease presentation ifbacilli intentionally aerosolized. ? Bubonic plague: most likely disease presentation if infected fleas released. Transmission: ? Person to person exposure to respiratory droplets (within 3 feet) ? Contact with infected animals ? Contact with infected, draining buboes Incubation Period: ? Pneumonic: 1 – 3 days; Bubonic 2 - 10 days. Clinical Disease: ? Pneumonic: acute onset high fever, chills, headache, myalgias,malaise, cough (hemoptysis) progressing rapidly to dyspnea, stridor, cyanosis, and death; gastrointestinal symptoms may be present. ? Bubonic: high fever, malaise, painful lymph nodes common in groin ? Septicemic: 80% of persons with bubonic become septic; 5 – 15% develop pneumonia. Diagnosis: Presumptive diagnosis: gram-negative coccobacilli with “safety-pin” bipolar staining on Gram, Wright, Giemsa, or Wayson stain of blood, sputum, CSF, or lymph node aspirates (if present). Treatment: (see overview) ? Early antibiotic treatment is critical to survival. Prophylaxis: (see overview) ? Early antibiotic prophylaxis is critical to preventing disease. Isolation: ? Pneumonic: Standard and Droplet Precautions ? Bubonic: Standard and Contact Precautions. Droplet Precautions if bubonic progresses to pneumonia. Any suspected case of plague ( Yersinia pestis ) MUST BE TREATED AS A PUBLIC HEALTH EMERGENCY and reported to the infection control practitioner [ insert telephone number ] and the local health department [ insert telephone number ] immediately .

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