Plague

Clinical presentation and forms

The primary and predominant form upon importation from endemic regions (e.g., Southeast Asia) is bubonic plague.

• Intoxication syndrome: acute onset, high fever, shaking chills, and inadequate patient behavior.
• Lymph node involvement: painful regional lymphadenitis involving surrounding tissues (periadenitis) with the development of hemorrhagic-necrotic inflammation.
• Hemodynamics: absolute tachycardia, hypotension, and dyspnea.
• Dynamics: rapid development of symptoms. When secondary foci appear in the lungs, secondary plague pneumonia develops with dyspnea and hemoptysis against sparse auscultatory findings.

Epidemiological history and diagnostics

To confirm the diagnosis, it is critically important to obtain an accurate epidemiological history:

• Stay in an endemic focus (e.g., rural areas of Vietnam shortly before the illness, fitting the incubation period).
• Contacts with potential reservoirs of infection — rodents (rats).
• Evidence of vector-borne transmission via flea bites.

To assess severity and objectify the condition, complete blood counts, biochemical blood profiles, coagulograms, acid-base balance and blood gas analysis, as well as chest radiography are used. Specific diagnostics include examining material from the peripheral part of the bubo and performing a biological assay in guinea pigs. Gross specimens and sputum may reveal bipolar-staining bacilli.

Differential diagnosis with tularemia

The clinical presentation of plague must be differentiated from tularemia and bacterial tonsillitis. Main differences of tularemia:

• Secondary generalized forms are virtually absent, and the bubonic form runs a benign course.
• Intoxication does not reach the level of infectious-toxic shock (ITS) and DIC syndrome.
• Buboes mature later and are not accompanied by destructive periadenitis.
• The hemogram at the peak of the disease shows leukopenia and a lymph-monocytic reaction, whereas plague is characterized by high leukocytosis and a leukemoid reaction.

Physician tactics and management

When a particularly dangerous infection is suspected, the physician must act strictly according to the algorithm:

1. Isolation: remain with the patient in the room and ensure strict isolation.
2. Notification: immediately report to the management of the medical organization, who will inform the Health Committee and the Sanitary and Epidemiological Surveillance Center (especially dangerous infections department).
3. Waiting: the physician does not leave the patient until the specialized consultation team arrives.
4. Hospitalization: carried out strictly to a box ward by a specialized team.

Management measures:

• Antibiotic therapy is initiated immediately after specimen collection for bacteriological studies due to the rapid progression of the disease.
• Etiotropic therapy: Streptomycin intramuscularly, followed by a combination of streptomycin and doxycycline.
• Pathogenetic therapy: detoxification infusions of colloid and crystalloid solutions.

Class and exam questions

What else to study on this topic

• Features of bacterial sepsis pathogens and the role of biofilms
• Characteristics of intracellular parasites and particularly dangerous infections
• Differences between sepsis in quarantine infections and traditional sepsis
• Nosocomial strains and their multi-drug resistance
• Anaerobic clostridial sepsis and generalized mycoses

Other topics in the section "Zoonotic infections — 2024 study guide"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.