Treatment of plague

Antibacterial and pathogenetic therapy

The key rule when infection is suspected is that antibiotic administration begins immediately after biological sample collection (sputum, blood, oropharyngeal swabs, or bubo punctate). Lymph node puncture is performed strictly outside the area of softening.

• Etiotropic treatment: The drug of choice is streptomycin. The regimen involves initial intravenous followed by intramuscular administration of 1.0 g twice daily. The total course duration is at least 10 days. In rare cases, therapy may be ineffective due to infection with a streptomycin-resistant strain (most commonly in laboratory-acquired infections).
• Pathogenetic therapy: Aims to relieve severe toxicosis and maintain homeostasis. Includes infusions of crystalloid and colloid solutions, cryoplasma transfusion, and the use of catecholamines for hemodynamic support.
• Respiratory and immune support: Oxygen therapy is mandatory (up to mechanical ventilation in severe pneumonia) along with the administration of immunoglobulins, such as pentaglobin.

Surgical treatment and discharge criteria

Surgical intervention in plague is strictly limited. The indication for surgery is solely the appearance of distinct fluctuation in the area of the bubo (e.g., femoral).

Discharge of a convalescent from the hospital is possible only after meeting all of the following criteria:

1. Persistent normalization of temperature for 30 days.
2. Complete resorption (regression) of the bubo.
3. Clinical and radiological resolution of pneumonia.
4. Strict bacteriological control: it is necessary to obtain 2 negative results from bubo punctate cultures (with an interval of 5–6 days) and 4 negative results from tonsillar swabs and sputum (with an interval of 3–5 days).

Anti-epidemic measures in the focus

If a person has been in contact with a patient suffering from the pneumonic form of plague without protective anti-plague gear, a strict observation protocol is applied:

• Isolation: Placement in an individual box.
• Monitoring: Twice-daily thermometry.
• Prophylaxis: Emergency intake of doxycycline (Doxycyclinum) per os at 0.2 g per day for a duration of 7 days.
• Control: Collection of throat swabs and sputum followed by three consecutive negative bacteriological tests.

It should be remembered that prior specific vaccination in a contact person does not protect against primary pneumonic infection, but merely prolongs the incubation period, making the onset of the disease stealthy.

Features of the clinical picture (from practice)

Severe disease is often accompanied by fulminant generalized DIC syndrome. Patients exhibit hemorrhagic-necrotic rash, massive hemoptysis (haemoptysis), and bloody vomiting (haematemesis).

In the bubonic form, especially in children with a history of contact with domestic animals (cats, dogs), it is important to pay attention to early signs of neurotoxicosis. Pronounced meningeal symptoms develop (nuchal rigidity, Kernig's and Brudzinski's signs), tactile hyperesthesia, photophobia, and hyperacusis. The cerebrospinal fluid (CSF) shows pleocytosis, and the CSF itself becomes opalescent.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Pathogenesis of DIC syndrome and hemorrhagic pulmonary edema in the primary pneumonic form.
• Laboratory identification of the pathogen culture: enzymatic, phagolysable, and agglutinable properties.
• Differential diagnosis of the bubonic form of plague with benign lymphoreticulosis (cat-scratch disease).
• Specifics of emergency diagnostics: antigen detection by ELISA and DNA detection by PCR.
• Features of cerebrospinal fluid examination in plague meningitis.

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

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