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Plague

(Pneumonic Plague; Bubonic Plague; Septicemic Plague; Pharyngeal Plague)

Definition

Plague is an infectious disease with an infamous past in human history. Because of its contagious nature, plague is a weapon of bioterrorism. Although it is not as common as it once was, outbreaks of plague do occur today.
Types of plague include:
Plague is treated with isolation and antibiotics.

Causes

Plague is caused by specific bacteria.
Bubonic and septicemic plagues are spread by bites from infected fleas. Transmission can also occur when a person comes in contact with infected tissue or bodily fluids from another person or animal.
Pneumonic plague is spread by droplets in the air when an infected person coughs or sneezes. The disease is transmitted to another person when the droplets are inhaled. Transmission by droplets is the only way pneumonic plague spreads among people.
Pneumonic Plague Transmission
Droplets from an infected person are inhaled into the lungs.
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Risk Factors

Factors that may increase your chance of getting plague include:
You can get more information about the distribution of plague from the Centers for Disease Control and Prevention (CDC).

Symptoms

Pneumonic plague may cause:
Bubonic plague may cause:
Septicemic plague may cause:
Complications of plague include shock , organ failure, and death.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may ask about the possible source of exposure.
Your bodily fluids will be tested. This can be done with:
Images may be taken of your lungs. This can be done with a chest x-ray.

Treatment

Starting antibiotics early is important. Any delay increases the risk of death. The drugs are injected in a muscle or given through a vein. Later in treatment, some drugs can be given by mouth. A person with lung symptoms will be placed in isolation to protect others. Caregivers and visitors should wear a mask, gloves, goggles, and a gown. Cases are reported to public health officials.

Supportive Care for Septicemic Plague

Health professionals will monitor those with septicemic plague for changes in status and take appropriate action. Maintaining adequate heart function, blood pressure, and oxygen supply are important.

Prevention

Antibiotics may prevent infection following close contact with someone who has the disease. The drugs should be taken daily while in contact, and for 7 days after the last exposure. In addition, the caregiver and person with plague should wear masks.
In the event of a terrorism exposure, antibiotics may be given to people in the affected areas who have a fever or cough. A vaccine does not exist for pneumonic plague.
Measures to prevent naturally occurring plague include:

RESOURCES

Centers for Disease Control and Prevention http://www.cdc.gov

Johns Hopkins' Office of Critical Event Preparedness and Response (CEPAR) http://www.hopkins-cepar.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Public Health Agency of Canada http://www.phac-aspc.gc.ca

References

Consensus statement, plague as a biological weapon: Medical and public health management. JAMA. 2000;283(17):2281-2290.

Plague. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/plague. Updated March 3, 2015. Accessed June 10, 2015.

Plague. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 12, 2015. Accessed June 10, 2015.

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