Plague

Question 1

Plague - bacteria

Answer 1

Yersinia pestis
Gram negative coccobacillus

Question 2

Plague - area with highest burden

Answer 2

95% in Africa
DRC, Madagascar, Uganda, Tanzania
Found between 55N and 40S: broad belt in tropical and subtropical latitudes and warmer parts of temperate latitudes

Question 3

Plague transmission

Answer 3

Mainly: vector [fleas = xenopsylla cheopis]
Also by: droplet, contact, faecal oral, airborne

Question 4

Bubonic plague - clinical features

Answer 4

Short IP 1-7 days
Smooth painful lymphadenopathy [bubos] - commonly on groin, axilla, cervical region
Additional S+S:
Bubos, chills, malaise, high fever, muscle cramps, seizures

Question 5

Pneumonic plague - clinical features

Answer 5

Short IP 2-4 days
Rapidly progressive pneumonia with pleuritic pain and blood tinged sputum

Question 6

Plague - diagnosis

Answer 6

Sputum or LN aspirate - gram stain [bipolar gram negative rods with safety pin appearance]
Blood culture
Lateral flow tests detecting F1 capsular antigen [F1RDT]

Question 7

Bipolar staining organisms

Answer 7

Yersinia pestis
Francisella
Burkholderia
Pasteurella
Other enterobacteriaceae

Question 8

Bubonic plague - treatment

Answer 8

Streptomycin or gentamicin and fluoroquinolone for 10 days

Question 9

Pneumonic plague - treatment

Answer 9

Streptomycin or doxycycline or gentamicin and fluoroquinolone

Question 10

Plague meningitis - treatment

Answer 10

Chloramphenicol and fluoroquinolone