Plague A20.9

Historically important anthropozoonosis occurring in epidemics. A distinction is made between bubonic plague (90% of cases), pestilence, pneumonic plague or abortive plague (Spyrou MA et al. 2019). Note: obligation to report!

• Bubonic plague (bubonic plague): flea bite, development of an inflammatory papule; painful regional lymphadenitis. Fever, toxic CNS symptoms (e.g. delirium). In bacteremia: petechiae, ecchymosis, consumption coagulopathy. Also: erythema, vesicles and pustules.
• Pulmonary plague: severe clinical picture with dyspnoea, cyanosis, haemoptoe. Without chemotherapy lethal course.
• Plague sepsis: fatal complication in the final stage of bubonic plague or pneumonic plague, even after small or undetectable bubons.
• Abortive plague: Mostly single bubo, slight fever. Purulent melting and healing.

Rapid initiation of effective antibiotic therapy (within 24 hours after the first symptoms appear). The first choice are streptomycin (e.g. Strepto-Fatol) 30 mg/kg bw/day i.m. in 2-3 doses or gentamicin (e.g. Refobacin) 3-5 mg/kg bw/day i.v. or i.m. spread over 3 doses over 5-10 days.

Alternatively: Erythromycin (erythrocin i.v.), adults 2 g/day i.v. in 4 cycles, children 20-30 mg/kg bw/day i.v. in 4 cycles. Alternatively: Doxycycline (e.g. Supracycline) initial 200 mg, then 100 mg p.o. twice a day for 10-14 days.

Bioterrorism with plague bacteria has been reported in the USA (Yang R 2017).

1. Spyrou MA et al.(2019) Phylogeography of the second plague pandemic revealed through analysis of historical Yersinia pestis genomes.Nat Commun 10:4470.

2. Yang R (2017) Plague: recognition, treatment, and prevention. J Clin Microbiol 56:e01519-17.