PLAGUE

Severe acute bacterial infection with high fatality rate transmitted by infected rodent fleas. It is a notifiable disease.

Cause

  • Yersinia pestis (a coccobacillus) transmitted from ground rodents to man by bites from infected fleas
  • It may also be spread from person to person by droplet infection and may occur in epidemics

Clinical features

TYPE FEATURES
Bubonic
(A20.0)
  • Involves lymph nodes (usually femoral
    and inguinal)
  • Rapidly rising temperature with rigors
  • Headache
Pneumonic
(A20.2)
  • Very infectious and highly fatal:
    PATIENT MUST BE ISOLATED

    • Death occurs within 2 days if not treated
      early
  • Infection is localised in the lungs with
    fever, general malaise, headache, and
    frothy blood stained sputum
  • May be complicated by respiratory and
    cardiac distress
Septicaemia
(A20.7)
  • Complication of the primary infection
    due to toxins
  • There is high fever, nose bleeding,
    diarrhoea, heart failure, disseminated
    intravascular coagulation, skin necrosis,
    and shock

Differential diagnosis

  • Malaria, typhoid
  • Lymphogranuloma venereum
  • Pneumonia

Investigations

  • Bubo aspirate: for microscopy, C&S
  • Blood and sputum: check for presence of the bacilli

Management

  • Doxycycline 100 mg every 12 hours for 14 days
    Child > 8 years: 2 mg/kg per dose

Alternatives:

  • Chloramphenicol 500 mg orally or IV every
    6 hours for 10 days
    Child: 25 mg/kg per dose
  • Or gentamicin 1.7 mg/kg (adult and child) IV or IM every 8 hours for 7-10 days

Note

  • For use in pregnancy, consider gentamicin

Prevention

  • Health education
  • Improved housing
  • Destruction of rats (rodents) and fleas
  • Early detection and treatment to reduce further spread