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Bioterrorism Agents – Plague Lesson 3 PowerPoint PPT Presentation

Bioterrorism Agents – Plague Lesson 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

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Bioterrorism Agents – Plague Lesson 3

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Bioterrorism agents plague lesson 3 l.jpg

Bioterrorism Agents – PlagueLesson 3

Differential Diagnosis


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Objectives

  • List the diseases that should be considered in the differential diagnosis of plague

  • Describe how to rule out other diseases when diagnosing plague


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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


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Bubonic Plague

  • Disease Progression

    • Septicemia

    • Pneumonic Plague

    • Meningitis (rare)

  • Other Symptoms

    • Restlessness, confusion, lack of coordination

    • Intestinal discomfort

    • Lymph nodes may suppurate second week


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Bubonic PlagueDifferential Diagnosis

  • Capnocytophaga canimorsus

  • Cellulitis

  • Lymphogranuloma venereum

  • Non-specific infections

Lymphogranuloma venereum


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Bubonic PlagueDifferential Diagnosis

© 2003 CIDRAP/IDSA


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Bubonic PlagueDifferential Diagnosis

© 2003 CIDRAP/IDSA


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Bubonic PlagueDifferential Diagnosis

© 2003 CIDRAP/IDSA


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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)


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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


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Pneumonic Plague


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Primary Pneumonic PlagueOutbreak Diagnoses

  • Presumptive; especially if associated

  • Rule out other causes

    • Severe pneumonia

    • Rapidly progressive respiratory infection

    • With or without sepsis


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Primary Pneumonic PlagueDifferential Diagnosis

  • Inhalational anthrax

  • Tularemia

  • Community-acquired bacterial pneumonia

  • Viral pneumonia

  • Q fever

Anthrax


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Primary Pneumonic PlagueDifferential Diagnosis

© 2003 CIDRAP/IDSA


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Primary Pneumonic PlagueDifferential Diagnosis

© 2003 CIDRAP/IDSA


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Primary Pneumonic PlagueDifferential Diagnosis

© 2003 CIDRAP/IDSA


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Septicemic Plague

  • Incubation: Most common as complication

  • Symptoms

    • Fever, chills, prostration

    • Gastrointestinal

  • Disease Progression

    • Pupura

    • DIC

    • Amputation

Pupura


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Septicemic PlagueDifferential Diagnosis

© 2003 CIDRAP/IDSA


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Review Questions

Plague Lesson 3


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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


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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?


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Plague Review QuestionLesson 3, Question 1

What diagnoses would you rule out?

  • Anthrax

  • Tularemia

  • Pneumonic Plague

  • Bubonic Plague


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Plague Review QuestionLesson 3, Question 1

What diagnoses would you rule out?

C. Pneumonic Plague


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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?


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Plague Review QuestionLesson 3, Question 2

What illnesses would you include in differential?

  • Tularemia

  • Chancroid

  • Cat-Scratch Fever

  • Bubonic Plague


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Plague Review QuestionLesson 3, Question 2

What illnesses would you include in differential?

D. Bubonic Plague


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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?


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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


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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


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