Plague (cont.)

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How is plague diagnosed?

The history and physical exam is an important first step in the diagnosis of plague. The patient's exposure to animals (and the fleas that accompany them) or exposure to humans that have plague or the symptoms of plague, or have visited or reside in a plague-endemic area can help trigger the medical caregivers' ability to do further tests for plague. In addition, if buboes develop in about three to seven days after exposures listed above, bubonic plague may be presumptively diagnosed. Unless septicemic or pneumonic plague develop directly from the bubonic form, the presumptive diagnosis is somewhat more difficult to make; sometimes because plague is seen so infrequently by many doctors. However, a good patient history can help make a more timely presumptive diagnosis. In addition, bleeding under the skin and other septicemic symptoms may be helpful. Laboratory tests are usually based on the detection of the F1 antigen of Y. pestis and can provide both a presumptive and definitive diagnosis of plague.

Definitive diagnosis of plague has also been done by PCR tests to detect the genetic material of Y. pestis antigens in animal, flea, and human tissues.

What is the treatment for the plague? What is the prognosis of the plague?

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Currently, plague is treated with antibiotics. The following antibiotics have been used to successfully treat plague if the person's disease has not yet overwhelmed the body's defenses (earlier treatments have a better chance to stop the disease):

Patients who are suspected of being exposed to plague should be treated immediately. The antibiotic, route of administration (IV or oral), duration of treatment and supportive care, if necessary, are determined by the patient's caregiver and usually in consultation with CDC or infectious-disease specialists. Plague is rarely seen in the U.S. (about 13 infections are diagnosed per year with one recent year with 40 diagnosed); however, about 14% of people who are diagnosed in the U.S. still die from the disease. The World Health Organization estimates about 2,900 individuals per year are diagnosed with plague currently.

The prognosis of untreated plague is poor. About 50%-90% of infected individuals will die if untreated. Even with appropriate treatment, about 14% of treated patients will still die from the disease. Those patients who recover may have sustained damage to one or more organs such as the lungs.

Medically Reviewed by a Doctor on 10/30/2013

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