– A zoonosis caused by the Gram-negative bacillus Yersinia pestis that mainly affects wild and domestic rodents.
– The transmission to humans may be indirect (flea bites) or direct (excoriated skin contact with rodents). The person transmission occurs through flea bites and by air to the lung form.
– Large animal outbreaks persist in Central Asia and South East,
Africa, Madagascar, North and South America.
Clinical signs and evolution:
There are 3 main clinical forms:
– Bubonic plague is the most common form of high fever, chills, headache, associated with one (or more) node usually very painful inguinal (bubo). frequent gastrointestinal symptoms: abdominal pain, vomiting, diarrhea, etc. Without treatment, death occurs in 50% of cases by septicemia.
– The septicemic plague is a complication of untreated bubonic plague, with lightning evolution.
– Pneumonic plague is a highly contagious form: high fever, chills, headache, myalgias associated with a hacking cough, hemoptysis and respiratory distress.
This form is rapidly progressive and fatal if untreated. It is either a complication of bubonic plague is a primary infection, following airborne transmission.
Occasionally, the disease may take the form of a plague meningitis.
Laboratory:
– Isolate the germ (direct examination and culture) by puncturing the bubo, blood culture, sputum collection or lumbar puncture, depending on the form.
– Serology ELISA positive soon after the onset of the disease.
– The transport of samples requires a cold chain (alternatively, not to exceed 30 ° C).
Course of action and treatment:
– In case of suspicion of plague: take samples for culture and susceptibility testing and immediate treatment without waiting for confirmation of diagnosis. Inform health authorities upon confirmation of the diagnosis.
– Isolation:
• For patients with bubonic plague, isolation is not necessary, treat the sick, his bedding, clothes with an insecticide(permethrin dusting powder 0.5%, for example, to the user manual). observe
basic hygiene (washing hands, wearing coat, gloves, etc.).
• Strict isolation for patients with primary or secondary pulmonary plague. Their bedding, clothing, sputum and feces should be disinfected with a chlorine solution. Observe basic hygiene (hand washing, blouse port, gloves, etc.) and mask wearing for patients and caregivers.
– Treatment of suspected cases
When treatment is begun early, recovery is rapid and complete. Penicillins, cephalosporins, and macrolides should not be used.
Aminoglycosides, tetracyclines, chloramphenicol and sulfonamides are active. Comply with the national protocol.Indicative aTitle: IM streptomycin for 10 days
Child: 30 mg / kg / day in 2 divided injections spaced 12 hours
Adult: 2 g / day in 2 divided doses at 12 hours gentamicin IM for 10 days
Newborns and children under one year: 7.5 mg / kg / day in 2 divided doses
Children over one year: 6 mg / kg / day in 2 divided doses
Adults: 3 mg / kg / day in 2 divided doses doxycycline PO for 10 days
Children over 8 years and adults: 200 mg / day in one or two taken chloramphenicol PO or IV for 10 days
Children over one year and adults: 50 mg / kg / day in 4 divided doses or injections every 6 hours.
Note: in order to avoid the development of resistance to streptomycin in tuberculosis treatment, preferably use doxycycline or chloramphenicol in bubonic plague.
– Chemoprophylaxis of contacts
In case of contact until a week after the end of exposure:
doxycycline PO for the contact time (minimum 5 days)
Children over 8 years and adults: 100 to 200 mg / day in one or two taken
or
cotrimoxazole PO for the contact time (minimum 5 days)
Children: 40 mg SMX + 8 mg TMP / kg / day in 2 divided doses
Adult: 1600 mg SMX + TMP 320 mg / day in 2 divided doses
Prevention:
– The fight against fleas plays an essential role in controlling an epidemic.
– Long-term prevention: sanitation and fight against rats.
– The vaccine against plague is reserved for people at high risk of exposure (laboratory personnel handling rodents) and may in no case be a way to fight outbreak.
