Pediatric emergency medicine trisk 4549 4549
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However, because plague, unlike smallpox, is spread by large respiratory
droplets, close contact is required for transmission.
Clinical Manifestations. Bubonic plague is characterized by the classic bubo, a
tender, enlarged, fluctuant lymph node in the distribution of the infected flea bite.
Fever and malaise are usually present. Bubonic plague may progress to
septicemia as bacteria gain access to the circulation; 80% of bubonic plague
victims have positive blood cultures. Petechiae, purpura, and overwhelming
disseminated intravascular coagulation (DIC) may develop.
Pneumonic plague may arise secondarily after blood-borne seeding of the lungs
or may be seen primarily after aerosol exposure. Symptoms include high fever,
chills, malaise, fatigue, headache, and cough. Chest radiographs may reveal a
patchy or consolidated bronchopneumonia, and the classic clinical finding is one
of blood-streaked sputum; DIC and an overwhelming sepsis may develop as the
disease progresses. Meningitis develops in 6% of cases. Untreated pneumonic
plague has a mortality rate approaching 100%.
A presumptive diagnosis of plague can be made by observing the classic
bipolar-staining “safety pin”—like rods in Gram or Wayson stains of sputum,
aspirated lymph node material, or cerebrospinal fluid. Confirmation is obtained
via blood, sputum, or aspirate culture.
Management. Droplet precautions should be employed in cases of suspected
pneumonic plague. Such precautions should be continued in confirmed cases until
sputum cultures are negative. Standard precautions are adequate in managing
bubonic plague victims. Given the incubation period, decontamination would not
be necessary in a clinical setting. See Table 132.3B for detailed treatment
recommendations for children.
Smallpox
CLINICAL PEARLS AND PITFALLS
