infectious diseases
Plague and Other Yersinia Infections
Key Points
Plague is a highly contagious, life-threatening infection now present in the US mainly in rural or semirural areas of the Southwest; worldwide, most cases since the 1990s have occurred in Africa. Plague may cause large, tender, often suppurative lymphadenopathy (buboes), severe pulmonary infection, and/or septicemia. Rapid diagnosis using stain and culture of the organism is important because mortality increases significantly the longer treatment is delayed. Place patients with pneumonic plague in strict respiratory isolation; routine isolation is adequate for those with other forms. Treat withstreptomycinorgentamicin; acceptable alternatives includedoxycycline,ciprofloxacin,levofloxacin, andchloramphenicol. Monitor close contacts carefully, treat them prophylactically withdoxycycline,ciprofloxacin, orlevofloxacin, and treat children with TMP/SMX; plague vaccine is no longer available in the US. 