Plague

FIGURE 24.2 Cutaneous Anthrax 1. Axial magnetic resonance image (MRI) with intravenous gadolinium contrast enhancement of the arm of a patient with cutaneous anthrax that demonstrates massive lymphedema and enhancement of the subcutaneous fat in the lateral compartment. (Courtesy of Carlos R. Gimenez, M.D., Professor of Radiology, LSU School of Medicine, New Orleans, LA.)

FIGURE 24.3 Cutaneous Anthrax 2. Coronal magnetic resonance image (MRI) with intravenous gadolinium contrast enhancement of the arm of a patient with cutaneous anthrax that demonstrates massive lymphedema and enhancement of the subcutaneous fat in the lateral compartment. (Courtesy of Carlos R. Gimenez, M.D., Professor of Radiology, LSU School of Medicine, New Orleans, LA.)

Microbiology: Yersinia pestis is a Gram-negative, safety-pin shaped coccobacillus. Pathology: Bubonic plague occurs in endemic areas from plague-infected rat flea bites and is characterized by fever, malaise, regional buboes, and possibly sepsis. Pneumonic plague occurs with a 2-3 day incubation period after direct respiratory contact or BW release and is characterized by headache, fever, chills, cough, hemoptysis, severe pneumonia, then respiratory failure with cardiovascular collapse and terminal coagulopathy.

Differential diagnosis: Community acquired pneumonia, hantavirus pulmonary syndrome, meningococcemia.

Diagnosis: Chest x-ray with severe pneumonia; sputum, blood, or bubo aspirate for Gram-negative coccobacilli with bipolar, safety-pin shape Gram-negative staining characteristics; blood culture with growth in 24 hours, often misdiag-nosed as Y. enterocolitica; antibodies detected by IgM ELISA, antigens detected by PCR. Treatment: Streptomycin IM 30 mg/kg/day for 10 days, and doxycycline 200 mg IV push, then 100 mg IV every 12 hours for 10 days; or genta-micin IV 5 mg/kg for 10 days. Prevention: Tetracycline 500 mg orally four times daily for 7 days, or doxycycline 100 mg orally twice daily for 7 days.

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