Bioterrorism Agents – Plague Lesson 3

Bioterrorism Agents – PlagueLesson 3 Differential Diagnosis

Objectives • List the diseases that should be considered in the differential diagnosis of plague • Describe how to rule out other diseases when diagnosing plague

Bubonic Plague • Incubation: 2 to 6 days • Symptoms • Chills, high fever • Swollen and painful lymph nodes in groin, thigh, underarm and/or neck • Buboes at site of inoculation • Lymph nodes not hot, skin smooth and red • Rapid pulse • Hypotension

Bubonic Plague • Disease Progression • Septicemia • Pneumonic Plague • Meningitis (rare) • Other Symptoms • Restlessness, confusion, lack of coordination • Intestinal discomfort • Lymph nodes may suppurate second week

Bubonic PlagueDifferential Diagnosis • Capnocytophaga canimorsus • Cellulitis • Lymphogranuloma venereum • Non-specific infections Lymphogranuloma venereum

Pneumonic Plague • Incubation: 2 to 4 days (Range: 1-6 days) • Symptoms • Fever, chills, malaise, myalgias • Productive cough, watery mucoid • Chest pain, dyspnea • Hemoptysis • Gastrointestinal • Cervical Bubo (rare)

Pneumonic Plague • Rapidly progressive • Respiratory failure within 2 to 4 days • Chest X-Rays – bilateral patchy infiltrates • Shock, hypotension, multi-organ failure • Treat within 24 hours or almost universally fatal

Pneumonic Plague

Primary Pneumonic PlagueOutbreak Diagnoses • Presumptive; especially if associated • Rule out other causes • Severe pneumonia • Rapidly progressive respiratory infection • With or without sepsis

Primary Pneumonic PlagueDifferential Diagnosis • Inhalational anthrax • Tularemia • Community-acquired bacterial pneumonia • Viral pneumonia • Q fever Anthrax

Septicemic Plague • Incubation: Most common as complication • Symptoms • Fever, chills, prostration • Gastrointestinal • Disease Progression • Pupura • DIC • Amputation Pupura

Review Questions Plague Lesson 3

Plague Review QuestionLesson 3, Question 1 • 36yo, F, Chicago, IL • Housekeeper • No hx of travel, animal exposure • Symptoms • Severe abdominal pain • Productive cough • Shortness of breath

Plague Review QuestionLesson 3, Question 1 • Exam Findings • Productive cough, thick, bloody sputum • Bilateral rales • Little-to-no air movement lower left lung field • Chest X-Ray – bilateral infiltrates • CSF – Cloudy • Temperature – 102.3F • Pulse rapid and thready • Liver not enlarged, no enlarged lymph nodes What diagnoses would you rule out?

Plague Review QuestionLesson 3, Question 1 What diagnoses would you rule out? • Anthrax • Tularemia • Pneumonic Plague • Bubonic Plague

Plague Review QuestionLesson 3, Question 1 What diagnoses would you rule out? C. Pneumonic Plague

Plague Review QuestionLesson 3, Question 2 • 32yo, M, Philadelphia, PA • Computer Programmer • No hx travel, Healthy dog • Symptoms • Headache, chills, fever x 2 days • Vomiting x 1 day • Orange-sized swelling, left inguinal • Delirious What illnesses would you include in differential?

Plague Review QuestionLesson 3, Question 2 What illnesses would you include in differential? • Tularemia • Chancroid • Cat-Scratch Fever • Bubonic Plague

Plague Review QuestionLesson 3, Question 2 What illnesses would you include in differential? D. Bubonic Plague

Plague Review QuestionLesson 3, Question 3 • 56yo, M, Miami, Florida • Salesman • Hx of Travel to New Mexico last week • No hx of animal exposure • Symptoms • Malaise, myalgia, chills, headache, GI sxs x 3 days • Worsening sx’s, severe abdominal, productive cough, shortness of breath x 1 day • Today – Pupura, DIC, hypotension How would you relate it to plague?

Plague Review QuestionLesson 3, Question 3 How would you relate it to plague? • Presence of gram-positive bacteria • Hx of travel to plague endemic area • Rapid progression of disease • B and C

Plague Review QuestionLesson 3, Question 3 How would you relate it to plague? • Both B and C Hx of travel to plague endemic area Rapid progression of disease

Bioterrorism Agents – Plague Lesson 3