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Plague. A clinical review of 27 cases
Abstract:
We reviewed the medical records of 27 patients with plague seen at the Gallup (NM) Indian Medical Center between 1965 and 1989. Nineteen patients had bubonic plague and eight had septicemic plague. Three patients with septicemic plague and three with bubonic plague died. The patients presented with five different clinical pictures. Ten patients presented with classic signs of plague, five with the appearance of an upper respiratory tract infection, five with a nonspecific febrile syndrome, four with the appearance of a gastrointestinal or urinary tract infection, and three with the appearance of meningitis. Blood cultures were positive in 24 of 25 cases, and bubo aspirate cultures were positive in 10 of 13 cases. All six patients who died were under 30 years old, and all the deaths were related to a failure to treat initially with an antibiotic appropriate for plague. Plague is a treatable disease, but clinicians must have a high index of suspicion and give appropriate antibiotics at the earliest possible time to patients whose presentation suggests plague.
Insights
Early antibiotic treatment is crucial for plague survival. Prompt diagnosis and appropriate medication can prevent fatalities, especially in younger patients presenting with diverse symptoms.
Area of Science:
- Infectious Diseases
- Bacteriology
- Epidemiology
Background:
- Plague is a serious bacterial infection caused by Yersinia pestis.
- It can manifest in various clinical forms, including bubonic and septicemic plague.
- Prompt diagnosis and treatment are essential for patient outcomes.
Purpose of the Study:
- To analyze the clinical presentations, diagnostic findings, and treatment outcomes of plague patients.
- To identify factors associated with mortality in plague cases.
- To emphasize the importance of early and appropriate antibiotic therapy.
Main Methods:
- Retrospective review of medical records of 27 plague patients treated between 1965 and 1989.
- Analysis of clinical presentations, diagnostic results (blood and bubo aspirate cultures), and treatment regimens.
- Correlation of patient demographics, clinical features, and outcomes.
Main Results:
- 27 plague cases were reviewed; 19 were bubonic and 8 were septicemic.
- Six patients died, all under 30 years old and linked to delayed or inappropriate antibiotic treatment.
- Diverse clinical presentations included classic plague, respiratory, nonspecific febrile, gastrointestinal/urinary, and meningitis-like syndromes.
- Blood cultures were positive in 24/25 cases; bubo aspirate cultures in 10/13.
Conclusions:
- Plague presents with varied clinical pictures, necessitating a high index of suspicion.
- Early administration of plague-appropriate antibiotics is critical for survival.
- Delayed or incorrect antibiotic treatment significantly increases mortality risk, particularly in young individuals.