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Published on: October 3, 2016
Bichat guidelines for the clinical management of plague and bioterrorism-related plague
Philippe Bossi1, Anders Tegnell, Agoritsa Baka
1Task Force on Biological and Chemical Agent Threats, Public Health Directorate, European Commission, Luxembourg. philippe.bossi@psl.ap-hop-paris.fr
Abstract:
Yersinia pestis appears to be a good candidate agent for a bioterrorist attack. The use of an aerosolised form of this agent could cause an explosive outbreak of primary plague pneumonia. The bacteria could be used also to infect the rodent population and then spread to humans. Most of the therapeutic guidelines suggest using gentamicin or streptomycin as first line therapy with ciprofloxacin as optional treatment. Persons who come in contact with patients with pneumonic plague should receive antibiotic prophylaxis with doxycycline or ciprofloxacin for 7 days. Prevention of human-to-human transmission via patients with plague pneumonia can be achieved by implementing standard isolation procedures until at least 4 days of antibiotic treatment have been administered. For the other clinical types of the disease, patients should be isolated for the first 48 hours after the initiation of treatment.
Insights
Yersinia pestis, a bioterrorism threat, can cause plague pneumonia via aerosols. Early antibiotic treatment with gentamicin or streptomycin and prophylaxis are key to managing outbreaks and preventing transmission.
Area of Science:
- Microbiology
- Public Health
- Bioterrorism Preparedness
Background:
- Yersinia pestis is a potential bioterrorism agent.
- Aerosolized Yersinia pestis can cause rapid, explosive outbreaks of pneumonic plague.
- The bacteria can also spread from rodents to humans, posing a zoonotic threat.
Purpose of the Study:
- To outline therapeutic guidelines for Yersinia pestis infections.
- To define antibiotic prophylaxis strategies for exposed individuals.
- To establish isolation protocols for preventing plague transmission.
Main Methods:
- Review of existing therapeutic guidelines for plague treatment.
- Analysis of recommended antibiotic regimens for pneumonic and other plague forms.
- Evaluation of isolation procedures and prophylaxis durations.
Main Results:
- Gentamicin or streptomycin are recommended as first-line therapies; ciprofloxacin is an alternative.
- Antibiotic prophylaxis with doxycycline or ciprofloxacin for 7 days is advised for contacts.
- Isolation of pneumonic plague patients for at least 4 days of treatment is crucial; other forms require 48-hour isolation.
Conclusions:
- Effective management of Yersinia pestis bioterrorism involves prompt antibiotic therapy and targeted prophylaxis.
- Strict isolation protocols are essential to prevent human-to-human transmission of pneumonic plague.
- Preparedness for Yersinia pestis as a bioterrorism agent requires understanding its transmission dynamics and implementing control measures.
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