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Section 3. Summaries of Infectious Diseases
Plague
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Naturally acquired plague most commonly
manifests in the bubonic form, with acute onset of fever and
painful swollen regional lymph nodes (buboes), whereas bioterrorism-related
plague would manifest chiefly as pneumonic plague. Buboes develop
most commonly in the inguinal region but also occur in axillary
or cervical areas. Less commonly, plague manifests in the septicemic
form (hypotension, acute respiratory distress, intravascular
coagulopathy) or as pneumonic plague (cough, fever, dyspnea,
and hemoptysis) and, rarely, as meningeal, pharyngeal, ocular,
or gastrointestinal plague. Abrupt onset of fever, chills, headache,
and malaise are characteristic in all cases. Occasionally, patients
have symptoms of mild lymphadenitis or prominent gastrointestinal
tract symptoms, which may obscure the correct diagnosis. When
left untreated, plague often will progress to overwhelming sepsis
with renal failure, acute respiratory distress syndrome, hemodynamic
instability, diffuse intravascular coagulation, and necrosis
of distal extremities. Plague has been referred to as black
death or blackwater fever.
ETIOLOGY: Plague is caused by
Yersinia pestis, a pleomorphic,
bipolar-staining, gram-negative coccobacillus.
EPIDEMIOLOGY: Plague is a zoonotic infection of rodents, carnivores,
and their fleas that occurs in many areas of the world, especially
Africa. Plague has been reported throughout the western United
States, but most human cases (approximately 85%) occur in New
Mexico, Arizona, California, and Colorado as isolated cases
or in small clusters. More cases occur during summers that follow
mild winters and wet springs. In the United States, human plague
is a rural disease, usually associated with epizootic infections
in ground squirrels, prairie dogs, and other wild rodents. Bubonic
plague usually is transmitted by bites of infected rodent fleas
or by direct contact with tissues and fluids of infected rodents
or other mammals, including domestic cats. Septicemic
. . . [Go to Full Text]
Related text in Red Book:
- Introduction
Red Book
2006: 735.
[Extract]
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