PlagueA20.9

Author:Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 15.06.2022

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Synonym(s)

Black death; Black Death; bubonic plague; Pestilentia; Pestis

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DefinitionThis section has been translated automatically.

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!

PathogenThis section has been translated automatically.

Yersinia (Pasteurella) pestis. Reservoir: rodents (especially rats) and their fleas.

Occurrence/EpidemiologyThis section has been translated automatically.

Currently limited endemic areas in Central Africa, Madagascar, Central Asia, Russia and America.

EtiopathogenesisThis section has been translated automatically.

Transmission of the pathogen by fleas (bubonic plague), contact with infected animals or by droplet infection from person to person (pneumonic plague).

Clinical featuresThis section has been translated automatically.

Incubation period: 1-6 days.
  • 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.

DiagnosisThis section has been translated automatically.

Only by cultivation of the pathogen (special laboratory, blood culture).

Differential diagnosisThis section has been translated automatically.

Tularemia, lymphogranuloma inguinale.

TherapyThis section has been translated automatically.

Isolation of the patient.

Internal therapyThis section has been translated automatically.

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.

Progression/forecastThis section has been translated automatically.

Lethality of bubonic plague untreated 50%, treated 10%.

ProphylaxisThis section has been translated automatically.

Safe protection of contact persons (post-exposure prophylaxis) with Doxycycline 2 times/day 100 mg p.o.

Note(s)This section has been translated automatically.

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

LiteratureThis section has been translated automatically.

  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.

Authors

Last updated on: 15.06.2022

Author: Prof. Dr. med. Peter Altmeyer