Plague Lesson 2: Clinical Presentation

1. Bioterrorism Agents – PlagueLesson 2 Clinical Presentation

2. Objectives • Identify distinctions between • Bubonic Plague • Pneumonic Plague • Septicemic Plague

3. Bubonic Plague • Incubation: 2 to 6 days • Symptoms • Lymphadenopathy, fever • Buboes at site of inoculation • Disease Progression - Untreated • Septicemia • Secondary Pneumonic Plague • Meningitis (rare)

4. Bubonic Plague

5. Bubonic Plague

6. Bubonic Plague

7. Pneumonic Plague • Incubation: 2 to 4 days (range 1 to 6 days) • Symptoms • Acute fever, chills, malaise, myalgias • Productive cough • Watery mucoid sputum, may be bloody • Associated chest pain, increasing dyspnea

8. Pneumonic Plague • Disease Progression • Adult Respiratory Distress Syndrome • Refractory pulmonary edema • Signs of shock • Without treatment in less than 24 hours, almost universally fatal

9. Pneumonic Plague • Coughing patient can spread • Respiratory precautions • Rapidly expanding infiltrates • Pulmonary parenchymal necrosis and hemorrhage • Occasional pulmonary abscesses • Enlarged hilar nodes and pleural effusions

10. Pneumonic Plague

11. Pneumonic Plague

12. Pneumonic Plague

13. Septicemic Plague • Incubation: Most common as complication of pneumonic or bubonic plague • Symptoms • Acute fever, chills, prostration, abdominal pain, nausea, vomiting • Disease Progression • Purpura • DIC • Hypotension and other signs of shock • Fatal if not treated

14. Other Plague Presentations • Pharyngeal Plague • Uncommon • Resembles tonsillitis with peritonsillar abcess • Cervical lymphadenopathy • Plague Meningitis • Most common in children • Usually end result of ineffective treatment of other forms • Symptoms mimic other forms of acute plague

15. Infection Control • Large numbers of plague bacilli • Respiratory droplet spread in close direct contact • Respiratory droplet precautions with suspect cases • Contact public health

16. Review Questions Plague Lesson 2

17. Plague Review QuestionsLesson 2, Question 1 • Gary, Indiana hospital • 12 month old from Gary • Acute onset fever, malaise, body aches x 2 days • Extremely tender lymph node under arm, 2 inches • Exhibiting neurologic symptoms Suspect plague meningitis. First step?

18. Plague Review QuestionsLesson 2, Question 1 What is your first step? • Call local health department • Rule out other diseases • Place in isolation

19. Plague Review QuestionsLesson 2, Question 1 What is your first step? A. Call your local health department

20. Plague Review QuestionsLesson 2, Question 2 • Patient presents after 24 hours with no treatment How would you expect the patient to progress?

21. Plague Review QuestionsLesson 2, Question 2 How would you expect the patient to progress? • It should resolve on its own • Septicemia, pneumonia, meningitis • Entire appendage involved. Amputation. • Kidney failure

22. Plague Review QuestionLesson 2, Question 2 How would you expect an untreated patient to progress? B. Septicemia, pneumonia, meningitis

23. BT Agents Home Plague: Lesson 2- Clinical Presentation BT Agents Module: Plague A. The best choice is B…. B. Correct. Adult respiratory distress syndrome (ARDS) characterized by refractory pulmonary edema may occur. Signs of shock including hypotension and eventual multi-organ failure may also occur. Without early detection and treatment in less than 24 hours, pneumonic plague is almost universally fatal. C. The best choice is B… D. The best choice is B… 3) You have a patient who you suspect has pneumonic plague. What is likely to happen if treatment is not offered within 24 hours? Module Introduction- Module Objectives Target Audience Continuing Education Credit Lessons-1) General Overview 2) Clinical Presentation 3) Differential Diagnosis 4) Laboratory Issues 5) Medical Management 6) Public Health Issues 7) Veterinarian Issues 8) Module Self-AssessmentAdditional Resources A. Once plague has progressed to the pneumonic form, it is too late for treatment to be offered. B. Without treatment within 24 hours, pneumonic plague is almost always fatal. C. It will progress to the bloodstream and cause septicemic plague. D. There is no progression of disease in cases of bubonic plague. Plague: Lesson 2- Clinical Presentation 9 of _ Do you want to review? Back Next

24. Plague Review QuestionsLesson 2, Question 3 • Suspect pneumonic plague What will happen without treatment in 24 hours?

25. Plague Review QuestionsLesson 2, Question 3 What will happen without treatment in 24 hours? • It’s too late for treatment • Almost always fatal • Septicemia • No progression

26. Plague Review QuestionsLesson 2, Question 3 What will happen without treatment in 24 hours? B. Almost always fatal