Plague, Bubonic

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Image of Plague, Bubonic

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ICD Codes

ICD-9-CM:
020.0 – Plague, bubonic

ICD-10-CM:
A20.0 – Bubonic plague

Synopsis

Plague is a severe bacterial infection that is caused by the gram-negative bacillus Yersinia pestis. Fleas transmit the bacteria from rodents to humans. Direct contact or animal bites are other sources. Endemic plague is seen in the southwestern US (Colorado, New Mexico, Arizona, California) and is associated with hunting and skinning animals. It is associated with exposures to prairie dogs, squirrels, chipmunks, rats, and infected cats. Exposure to infected animal carcasses (coyotes, hares, rabbits, rodents, marmots, goats) is also responsible for human infection. In other parts of the world, plague is seen in Vietnam, India, and parts of Africa.

Yersinia pestis can cause 3 types of infection: bubonic plague, septicemic plague (bubonic plague associated with sepsis and delirium), and pneumonic plague (acquired by respiratory droplet spread). Untreated bubonic plague can progress to septicemic plague in 2–6 days, and septicemic and pneumonic forms can occur without antecedent bubonic plague. In plague, a severe illness develops with sudden onset of malaise, myalgias, high fever, headache, and tachycardia. Septicemia leading to shock and death is frequent in untreated patients. The incubation period is 4–7 days.

Approximately 10 cases of endemic plague are reported each year in the United States.

In a bioterrorist event, plague would most likely be transmitted in an aerosol form, resulting in a highly lethal and contagious pneumonia. Bubonic plague would not immediately result but could be transmitted by infected fleas.

In 1995, a strain of multi-drug resistant (MDR) Y. pestis was isolated from a bubonic plague patient in Madagascar that was resistant to at least 8 antimicrobials, including streptomycin, tetracycline, chloramphenicol, and sulfonamides. To date, this is the only documented case of MDR Y. pestis, although there is no systematic monitoring of resistance.

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