I had personally thought that all of the plagues were long gone.  Here in New Mexico  (where I live) we have had three cases of the pneumonic plague in 2017.  Three!! Maybe that's not as crazy of a fact to other people, but I was pretty amazed.  Apparently there were only nine cases total in 2015.  At our hospital they told us to keep in mind the symptoms of the plague when treating our patients because we have had local cases.  So, what did I need to do?  Look up what on earth happens to patients who have the plague.

Doctors during the time of the plague wore these primitive gas masks to prevent themselves from contracting the disease.

Doctors during the time of the plague wore these primitive gas masks to prevent themselves from contracting the disease.

The Plague

The plague occurs in the Western United States and is commonly transmitted by fleas.  It cycles through rodents but can also affect pets and humans. 

According to the Center for Disease Control, the most common ways of getting the plague are as follows:

  • Getting bit by an infected fleas
  • Touching or skinning infected animals (rodents, rabbits, prairie dogs, rats)
  • Inhaling droplets from an infected person or animal

Diagnosis

There are three different versions of the plague: bubonic, septicemic, and pneumonic.  The plague usually starts as the bubonic plague manifesting with a bubo (swollen lymph node) in the groin, axillae, or cervical lymph nodes. These are extremely painful and the patient shows extreme guarding in this region.  The incubation period is 2 to 6 days.

If the bubonic plague spreads to the bloodstream, it then becomes septicemic plague.  If it spreads to the lungs, it then becomes pneumonic plague.  Symptoms can include swollen lymph nodes as well as fever, cough, chills, difficulty breathing, and bloody sputum (if progression to pneumonic plague occurs). Septicemic plague can include very non-specific symptoms such as nausea, vomiting, diarrhea, and abdominal pain. 

Diagnostic Testing

Patients who are suspected of having the plague should have blood cultures, lymph node aspiration, and sputum samples taken depending on the type of plague they are experiencing. This can provide a definitive diagnosis. Patients with pneumonic symptoms need to be placed in droplet precautions. This also needs to be reported to local and state authorities.

Treatment

All of the forms of the plague can be treated with antibiotic therapy.  If suspected of having the plague, providers should start the patients on prophylactic antibiotics.  Gentamicin and fluoroquinolones are typically first-line treatments in the United States. Patients must be treated quickly to avoid serious complications or even death.

References

New Mexico Department of Health

Centers for Disease Control Information Sheet

Centers for Disease Control Resource for Clinicians