Yersinia pestis infection medical therapy: Difference between revisions
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==Treatment of plague during pregnancy and in children== | ==Treatment of plague during pregnancy and in children== | ||
With correct and early therapy, [[complications]] of plague in [[pregnancy]] can be prevented. | With correct and early therapy, [[complications]] of plague in [[pregnancy]] can be prevented. | ||
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* [[Chloramphenicol]] carries a low risk of "[[Gray baby syndrome|gray baby]]" syndrome or [[bone marrow]] suppression. | * [[Chloramphenicol]] carries a low risk of "[[Gray baby syndrome|gray baby]]" syndrome or [[bone marrow]] suppression. | ||
* An [[aminoglycoside]] judiciously administered is effective and safe for both mother and [[fetus]], and in children. Because of its safety, [[intravenous]] or [[intramuscular]] administration, and ability to have blood concentrations monitored, [[gentamicin]] is the preferred [[antibiotic]] for treating plague in pregnancy.<ref name="pmid10807389">{{cite journal| author=Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E et al.| title=Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. | journal=JAMA | year= 2000 | volume= 283 | issue= 17 | pages= 2281-90 | pmid=10807389 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10807389 }} </ref> | * An [[aminoglycoside]] judiciously administered is effective and safe for both mother and [[fetus]], and in children. Because of its safety, [[intravenous]] or [[intramuscular]] administration, and ability to have blood concentrations monitored, [[gentamicin]] is the preferred [[antibiotic]] for treating plague in pregnancy.<ref name="pmid10807389">{{cite journal| author=Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E et al.| title=Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. | journal=JAMA | year= 2000 | volume= 283 | issue= 17 | pages= 2281-90 | pmid=10807389 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10807389 }} </ref> | ||
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Persons who have been in close contact with a plague patient, particularly a patient with plague pneumonia, should be identified and evaluated. The [[U.S. Public Health Service]] requires that all cases of suspected plague be reported immediately to local and state health departments and that the diagnosis be confirmed by [[CDC]]. As required by the International Health Regulations, [[CDC]] reports all U.S. plague cases to the [[World Health Organization]]. Early treatment of [[pneumonic plague]] is essential. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms. Several types of [[antibiotics]] are effective for curing the disease and for preventing it. | Persons who have been in close contact with a plague patient, particularly a patient with plague pneumonia, should be identified and evaluated. The [[U.S. Public Health Service]] requires that all cases of suspected plague be reported immediately to local and state health departments and that the diagnosis be confirmed by [[CDC]]. As required by the International Health Regulations, [[CDC]] reports all U.S. plague cases to the [[World Health Organization]]. Early treatment of [[pneumonic plague]] is essential. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms. Several types of [[antibiotics]] are effective for curing the disease and for preventing it. | ||
Antibiotic treatment for 7 days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection. However, antibiotic treatment alone is insufficient for some patients, who may also require circulatory, ventilator, or [[kidney|renal]] support. | Antibiotic treatment for 7 days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection. However, antibiotic treatment alone is insufficient for some patients, who may also require circulatory, ventilator, or [[kidney|renal]] support. |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editors-In-Chief: Esther Lee, M.A.; João André Alves Silva, M.D. [2]
Overview
According to treatment experts, a patient diagnosed with suspected plague should be hospitalized and medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of lymph gland, blood, and sputum samples. Antibiotic treatment should begin as soon as possible after laboratory specimens are taken. Effective antibiotics are streptomycin, gentamicin (used when streptomycin is not available), tetracyclines and chloramphenicol. (used for critically ill patients, or rarely for suspected neuro-involvement)
Medical Therapy
When a diagnosis of human plague is suspected on clinical and epidemiological grounds, appropriate specimens for diagnosis should be obtained immediately and the patient should be started on specific antimicrobial therapy without waiting for a definitive answer from the laboratory.[1][2]
Suspect plague patients with evidence of pneumonia should be placed in isolation, and managed under respiratory droplet precautions.[3]
Specific Therapy
Aminoglycosides
Streptomycin is the most effective antibiotic against Yersinia pestis and the drug of choice for treatment of plague, particularly the pneumonic form. Therapeutic effect may be expected with 30 mg/kg/day (up to a total of 2 g/day) in divided doses given intramuscularly, to be continued for a full course of 10 days of therapy or until 3 days after the temperature has returned to normal.[1][4][5][6][7]
Gentamicin has been found to be effective in animal studies, and is used to treat human plague patients.[1]
Chloramphenicol
Chloramphenicol is a suitable alternative to aminoglycosides in the treatment of bubonic or septicaemic plague and is the drug of choice for treatment of patients with Yersinia pestis invasion of tissue spaces into which other drugs pass poorly or not at all (such as plague meningitis, pleuritis, or endophthalmitis. Dosage should be 50 mg/kg/day administered in divided doses either parenterally or, if tolerated, orally for 10 days. Chloramphenicol may be used adjunctively with aminoglycosides.[1]
Tetracyclines
This group of antibiotics is bacteriostatic but effective in the primary treatment of patients with uncomplicated plague. An oral loading dose of 15 mg/kg tetracycline (not to exceed 1 g total) should be followed by 25-50 mg/kg/day (up to a total of 2 g/day) for 10 days. Tetracyclines may also be used adjunctively with other antibiotics.[1]
Sulfonamides
Sulfonamides have been used extensively in plague treatment and prevention: however, some studies have shown higher mortality, increased complications, and longer duration of fever as compared with the use of streptomycin, chloramphenicol or tetracycline antibiotics. Sulfadiazine is given as a loading dose of 2-4 g followed by a dose of 1 g every 4-6 hours for a period of 10 days. In children, the oral loading dose is 75 mg/kg, followed by 150 mg/kg/day orally in six divided doses. The combination drug trimethoprim-sulfamethoxazole has been used both in treatment and prevention of plague.[1]
Fluoroquinolones
Fluoroquinolones, such as ciprofloxacin, have been shown to have good effect against Y. pestis in both in vitro and animal studies. Ciprofloxacin is bacteriocidal and has broad spectrum activity against most Gram-negative aerobic bacteria, including Enterobacteriaceae and Pseudomonas aeruginosa, as well as against many Gram-positive bacteria. Although it has been used successfully to treat humans with Francisella tularensis infection, no studies have been published on its use in treating human plague.[1]
Other classes of antibiotics
Other cases of antibiotics, such as penicillins, cephalosporins, and macrolides have been shown to be ineffective or of variable effect in treatment of plague and they should not be used for this purpose.[1]
Supportive therapy
The clinician must prepare for intense supportive management of plague complications, utilizing the latest developments for dealing with Gram-negative sepsis.[8] Aggressive monitoring and management of possible septic shock, multiple organ failure, adult respiratory distress syndrome (ARDS) and disseminated intravascular coagulopathy should be instituted.[1]
Treatment of plague during pregnancy and in children
With correct and early therapy, complications of plague in pregnancy can be prevented.
The choice of antibiotics during pregnancy is confounded by the potential adverse effects of three of the most effective drugs.
- Streptomycin may be ototoxic and nephrotoxic to the fetus .
- Tetracycline has an adverse effect on developing teeth and bones of the fetus.
- Chloramphenicol carries a low risk of "gray baby" syndrome or bone marrow suppression.
- An aminoglycoside judiciously administered is effective and safe for both mother and fetus, and in children. Because of its safety, intravenous or intramuscular administration, and ability to have blood concentrations monitored, gentamicin is the preferred antibiotic for treating plague in pregnancy.[9]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 "Plague manual--epidemiology, distribution, surveillance and control". Wkly Epidemiol Rec. 74 (51–52): 447. 1999. PMID 10635759.
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ Garner JS (1996). "Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee". Infect Control Hosp Epidemiol. 17 (1): 53–80. PMID 8789689.
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ SMADEL JE, WOODWARD TE, AMIES CR, GOODNER K (1952). "Antibiotics in the treatment of bubonic and pneumonic plague in man". Ann N Y Acad Sci. 55 (6): 1275–84. PMID 13139207.
- ↑ Meyer, K. F.; Quan, S. F.; McCrumb, F. R.; Larson, A. (1952). "EFFECTIVE TREATMENT OF PLAGUE". Annals of the New York Academy of Sciences. 55 (6): 1228–1274. doi:10.1111/j.1749-6632.1952.tb22687.x. ISSN 0077-8923.
- ↑ Butler T, Levin J, Linh NN, Chau DM, Adickman M, Arnold K (1976). "Yersinia pestis infection in Vietnam. II. Quantiative blood cultures and detection of endotoxin in the cerebrospinal fluid of patients with meningitis". J Infect Dis. 133 (5): 493–9. PMID 1262715.
- ↑ Wheeler, Arthur P.; Bernard, Gordon R. (1999). "Treating Patients with Severe Sepsis". New England Journal of Medicine. 340 (3): 207–214. doi:10.1056/NEJM199901213400307. ISSN 0028-4793.
- ↑ Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E; et al. (2000). "Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense". JAMA. 283 (17): 2281–90. PMID 10807389.