Plague

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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

Differential diagnosis

• Malaria, typhoid
• Lymphogranuloma venereum
• Pneumonia

Investigations

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

Management

Treatment	LOC
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	HC2       HC4

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