ملخص

Plague

it is transmitted to humans by bites with infected fleas

Pneumonic plague

The onset is very sudden after respiratory infection with Y. pestis, with dyspnoea, and cough. The patient expectorates copious blood-stained frothy and highly infective sputum, and then becomes cyanosed and dies.
Septicaemic plague
The patient is toxic, and may have gastrointestinal symptoms. DIC and bleeding with ecchymoses may occur together with hypotension, shock, renal failure and acute respiratory distress
Bubonic plague
the most common, starts suddenly with rigor, high fever, and severe headache. The patients have rapid pulse, hypotension, and mental confusion with splenomegaly. At the site of infected lymph nodes there are aching and swelling, and “bubos” develop at the groin region from swollen lymph nodes and surrounding tissues.

Management

1. Start antibiotic immediately (even before sample collection):
First choice: Streptomycin or gentamicin
Alternative: Tetracycline and chloramphenicol
2. Treatment of acute circulatory failure, DIC, and hypoxia may be needed
Investigations
1. Stained smear
2. Culture
3. Immunofluorescence staining
4. PCR


Prophylactic doxycycline used in Contacts with pneumonic plague
caused by Yersinia pestis plague

Anthrax

caused by inoculation of spores of Bacillus anthracis

3. Inhalation anthrax

This type is very rare, , and carries a high mortality rate of 50-90%. After 3-14 days of exposure the patients develop fever, dyspnoea, cough, headache, and symptoms of septicaemia.
2. Gastrointestinal anthrax
ingestion of contaminated meat food products. The caecum is the site of infection leading to nausea, vomiting followed in 2-3 days by severe abdominal pain and bloody diarrhea, with rapid development of toxaemia and death.
1. Cutaneous anthrax
the most common type. The spores enter into the skin, and a single lesion may develop as an irritable papule on an oedematous haemorrhagic base. This lesion progresses to a depressed black eschar .

Management

Skin lesions are curable with early antibiotic therapy .
1. Ciprofloxacin. Addition of an aminoglycoside improves the outcome (synergism).
2. Ciprofloxacin or doxycycline in case of possibility of addtional inhalation
3. Prophylactic ciprofloxacin is used for high risk exposure.