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Bubonic Plague

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Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary


Table of Contents

Introduction

Bubonic plague is a bacterial disease caused by the organism Yersinia pestis. It is transmitted by the bite of an infected flea, carried by rodents, and has been responsible throughout history for many epidemics. One of the most famous occurred in 1348, known as the Black Death, which progressed through Asia and Western Europe, killing approximation one-third of the population.

For healthcare providers out there, Yersinia pestis is a gram negative rod that is acceptable to a variety of antibiotics, which will be discussed under medical treatment.

In the United States, hosts that carry Yersinia pestis include the white-footed deer mouse, voles, prairie dogs, as well as ground squirrels. Western United States has had their fair share of instances of plague. These states include New Mexico, Arizona, California, Colorado, Nevada, and Utah. From 1944-1993, there have been 362 cases of human plague in the United States. 90% of these have occurred in Arizona, California, Colorado and New Mexico. In 1995, there were 3 cases of plague in New Mexico and 2 in California, as well as one case in Arizona.

There are 3 different types of plague: bubonic, septicemic and pneumonic, the most common being bubonic.

Dogs and cats can acquire plague. Dogs usually do not become very ill. However cats can become very ill and can die from pneumonic plague, and cats can transmit plague to humans by their bite.

Bubonic Plague Symptoms

The most common form of pain is bubonic plague, characterized by buboes, which are large, very tender lymph nodes, which feel like nodules. These usually form away from the fleabite. The incubation period is approximately 2-6 days before symptoms start, and it is not uncommon to have very dark, blackened lesions that occur on the skin, hence the name “black death.” Of the 71 cases of plague reported in New Mexico between 1980 and 1984, 18 were septicemic.

Plague is much more common in individuals less than 40 years old. This is probably due to greater outdoor activity. The white-footed deer mouse was thought to be the culprit in these cases. The white-footed deer mouse is also a common culprit in the hanta virus.

Bubonic Plague Treatment

Healthcare provider - Medical Treatment
A thorough history is imperative when contemplating a diagnosis of plague. Does the person hunt? Have they recently traveled to Western United States or to another country? Have they done any skinning of animals? Signs and symptoms if plague is suspected, lymphadenopathy, high fever, fatigue, tachycardia, tachypnea, and abdominal symptoms, especially if they have come from an endemic area. Antibiotic therapy should be started immediately, even before labs are back.

Diagnosis is based on cultures of the organism from sputum, transtracheal aspirate, blood or aspirates of the buboes.

The drug of choice is Streptomycin. However this should not be given too rapidly. The recommended dose is 30 mg./kilogram a day intramuscularly, and 4 divided doses every 6 hours for 5 days. Individuals with renal impairment should have the dose modified appropriately. Tetracycline is also used and usually used concurrently with Streptomycin. The recommended loading dose is 15 mg./kilogram orally, all the way up to one gram for a total dose. This is then followed by 40-50 mg./kilogram in 6 divided doses every 4 hours on the first day. After that, you can go to 30 mg./kilogram orally in 4 divided doses every 6 hours for 10-14 days.

For further information, please see Wilderness Medicine by Dr. Auerbach.





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