0071643192.pdf

EMS AND DISASTER MEDICINE

Forms of disease:

■ Bubonic(skin)
■ Bacilli migrate to regional lymph nodes →bubo.
■ Pneumonic(inhalational)
■ Most common
■ May be transmitted person to person
■ Septicemia (from secondary dissemination)

SYMPTOMS/EXAM

Bubonic Plague

■ Two to three days incubation followed by:
■ Regionalpainfullymph node inflammation and necrosis (bubo, see
Figure 20.7)
■ Fevers, chills, malaise
■ Will disseminate over next week in 50% (if untreated) →septicemia

Pneumonic Plague

■ Two to three days incubation followed by:
■ Abrupt onset of fevers, chills, and flulike illness
■ Severe pneumonia in 24 hours
■ Patients may develop meningitis, liver injury, coagulation disturbances,
and gangrene in extremities (black death).

Septicemic Plague

■ Characterized by endotoxemia, shock, DIC, and coma

DIAGNOSIS

■ Suspect in any healthy individual who develops overwhelming Gram-
negative sepsis.
■ Gram stain and culture all body fluids.

FIGURE 20.7. Plague: An inguinal bubo.

(Courtesy of the CDC.)

Pneumonic plague is due to

inhalation of Y. pestis(Gram-

negative bacillus), normally

found in flea feces.

Half of untreated patients with

bubonic plague will develop

septicemia from bacterial

dissemination.