bioterrorism agents plague lesson 3 l.
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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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Presentation Transcript
objectives
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
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 plague4
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 plague differential diagnosis
Bubonic PlagueDifferential Diagnosis
  • Capnocytophaga canimorsus
  • Cellulitis
  • Lymphogranuloma venereum
  • Non-specific infections

Lymphogranuloma venereum

pneumonic plague
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 plague10
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
primary pneumonic plague outbreak diagnoses
Primary Pneumonic PlagueOutbreak Diagnoses
  • Presumptive; especially if associated
  • Rule out other causes
    • Severe pneumonia
    • Rapidly progressive respiratory infection
    • With or without sepsis
primary pneumonic plague differential diagnosis
Primary Pneumonic PlagueDifferential Diagnosis
  • Inhalational anthrax
  • Tularemia
  • Community-acquired bacterial pneumonia
  • Viral pneumonia
  • Q fever

Anthrax

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

Pupura

review questions

Review Questions

Plague Lesson 3

plague review question lesson 3 question 1
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 question lesson 3 question 121
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 question lesson 3 question 122
Plague Review QuestionLesson 3, Question 1

What diagnoses would you rule out?

  • Anthrax
  • Tularemia
  • Pneumonic Plague
  • Bubonic Plague
plague review question lesson 3 question 123
Plague Review QuestionLesson 3, Question 1

What diagnoses would you rule out?

C. Pneumonic Plague

plague review question lesson 3 question 2
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 question lesson 3 question 225
Plague Review QuestionLesson 3, Question 2

What illnesses would you include in differential?

  • Tularemia
  • Chancroid
  • Cat-Scratch Fever
  • Bubonic Plague
plague review question lesson 3 question 226
Plague Review QuestionLesson 3, Question 2

What illnesses would you include in differential?

D. Bubonic Plague

plague review question lesson 3 question 3
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 question lesson 3 question 328
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 question lesson 3 question 329
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