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Bioterrorism Agents – Plague Lesson 3

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

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Bioterrorism Agents – Plague Lesson 3

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  1. Bioterrorism Agents – PlagueLesson 3 Differential Diagnosis

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

  3. 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

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

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

  6. Bubonic PlagueDifferential Diagnosis © 2003 CIDRAP/IDSA

  7. Bubonic PlagueDifferential Diagnosis © 2003 CIDRAP/IDSA

  8. Bubonic PlagueDifferential Diagnosis © 2003 CIDRAP/IDSA

  9. 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)

  10. 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

  11. Pneumonic Plague

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

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

  14. Primary Pneumonic PlagueDifferential Diagnosis © 2003 CIDRAP/IDSA

  15. Primary Pneumonic PlagueDifferential Diagnosis © 2003 CIDRAP/IDSA

  16. Primary Pneumonic PlagueDifferential Diagnosis © 2003 CIDRAP/IDSA

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

  18. Septicemic PlagueDifferential Diagnosis © 2003 CIDRAP/IDSA

  19. Review Questions Plague Lesson 3

  20. 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

  21. 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?

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

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

  24. 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?

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

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

  27. 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?

  28. 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

  29. 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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