1921
Volume 102, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

In late 2017, Madagascar experienced a large urban outbreak of pneumonic plague, the largest outbreak to date this century. During the outbreak, there were widespread reports of plague patients presenting with atypical symptoms, such as prolonged duration of illness and upper respiratory tract symptoms. Reported mortality among plague cases was also substantially lower than that reported in the literature (25% versus 50% in treated patients). A prospective multicenter observational study was carried out to investigate potential reasons for these atypical presentations. Few subjects among our cohort had confirmed or probable plague, suggesting that, in part, there was overdiagnosis of plague cases by clinicians. However, 35% subjects reported using an antibiotic with anti-plague activity before hospital admission, whereas 55% had antibiotics with anti-plague activity detected in their serum at admission. Although there may have been overdiagnosis of plague by clinicians during the outbreak, the high frequency of community antibiotic may partly explain the relatively few culture-positive sputum samples during the outbreak. Community antibiotic use may have also altered the clinical presentation of plague patients. These issues make accurate detection of patients and the development of clinical case definitions and triage algorithms in urban pneumonic plague outbreaks difficult.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.19-0576
2020-04-06
2020-09-25
Loading full text...

Full text loading...

/deliver/fulltext/14761645/102/6/tpmd190576.html?itemId=/content/journals/10.4269/ajtmh.19-0576&mimeType=html&fmt=ahah

References

  1. World Health Organization, 2017. Plague Outbreak. Geneva, Switzerland: WHO, 16.
    [Google Scholar]
  2. Randremanana R et al., 2019. Epidemiological characteristics of urban plague epidemic in Madagascar, August–November 2017: an outbreak report. Lancet Infect Dis 19: 537545.
    [Google Scholar]
  3. World Health Organization, 2016. Plague around the world, 2010–2015. Wkly Epidemiol Rec 26: 8993.
    [Google Scholar]
  4. Pollitzer R, 1953. Plague studies. VIII. Clinical aspects. Bull World Health Organ 9: 59129.
    [Google Scholar]
  5. Prentice MB, Rahalison L, 2007. Plague. Lancet 369: 11961207.
    [Google Scholar]
  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: 12751284.
    [Google Scholar]
  7. Nguyen-Van-Ai, Nguyen-Duc-Hanh, Pham-Van-Dien, Nguyen-Van-Le, 1973. Co-trimoxazole in bubonic plague. Br Med J 4: 108109.
    [Google Scholar]
  8. Center for Disease Control and Prevention, 2015. Recommended Antibiotic Treatment for Plague. Available at: https://www.cdc.gov/plague/resources/Recommended-antibiotics-for-plague_revision-Aug-2015_Final-(00000002).pdf.
  9. Chanteau S, Rahalison L, Ralafiarisoa L, Foulon J, Ratsitorahina M, Ratsifasoamanana L, Carniel E, Nato F, 2003. Development and testing of a rapid diagnostic test for bubonic and pneumonic plague. Lancet 361: 211216.
    [Google Scholar]
  10. Hendaus M, Jomha F, Alhammadi A, 2015. Virus-induced secondary bacterial infection: a concise review. Ther Clin Risk Manag 11: 12651267.
    [Google Scholar]
  11. Trong P, Nhu TQ, Marshall JD, 1967. A mixed pneumonic bubonic plague outbreak in Vietnam. Mil Med 132: 9397.
    [Google Scholar]
  12. Kamugisha ML, Gesase S, Minja D, Mgema S, Mlwilo TD, Mayala BK, Msingwa S, Massaga JJ, Lemnge MM, 2007. Pattern and spatial distribution of plague in Lushoto, north-eastern Tanzania. Tanzan Health Res Bull 9: 1218.
    [Google Scholar]
  13. Bertherat E et al., 2011. Lessons learned about pneumonic plague diagnosis from 2 outbreaks, democratic republic of the Congo. Emerg Infect Dis 17: 778784.
    [Google Scholar]
  14. Hänsch S, Cilli E, Catalano G, Gruppioni G, Bianucci R, Stenseth NC, Bramanti B, Pallen MJ, 2015. The pla gene, encoding plasminogen activator, is not specific to Yersinia pestis. BMC Res Notes 8: 535.
    [Google Scholar]
  15. Girling DJ, 1982. Adverse effects of antitubereulosis drugs. Drugs 23: 5674.
    [Google Scholar]
  16. Mwengee W, Butler T, Mgema S, Mhina G, Almasi Y, Bradley C, Formanik JB, Rochester CG, 2006. Treatment of plague with gentamicin or doxycycline in a randomized clinical trial in Tanzania. Clin Infect Dis 42: 614621.
    [Google Scholar]
  17. Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S, 2011. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis 11: 692701.
    [Google Scholar]
  18. Lerbech AM, Opintan JA, Bekoe SO, Ahiabu MA, Tersbøl BP, Hansen M, Brightson KT, Ametepeh S, Frimodt-Møller N, Styrishave B, 2014. Antibiotic exposure in a low-income country: screening urine samples for presence of antibiotics and antibiotic resistance in coagulase negative staphylococcal contaminants. PLoS One 9: e113055.
    [Google Scholar]
  19. Dutt AK, Akhtar R, McVeigh M, 2006. Surat plague of 1994 re-examined. Southeast Asian J Trop Med Public Health 37: 755760.
    [Google Scholar]
  20. Rasoamanana B, Leroy F, Boisier P, Rasolomaharo M, Buchy P, Carniel E, Chanteau S, 1997. Field evaluation of an immunoglobulin G anti-F1 enzyme-linked immunosorbent assay for serodiagnosis of human plague in Madagascar. Clin Diagn Lab Immunol 4: 587591.
    [Google Scholar]
  21. McCrumb FR, Mercier S, ChenTH, Meyer KF, Goodner K, 1955. Studies on the antibody patterns in pneumonic plague patients. J Infect Dis 96: 8894.
    [Google Scholar]
  22. Brink WR, Rammelkamp CH, Denny FW, Wannamaker LW, 1951. Effect of penicillin and aureomycin on the natural course of streptococcal tonsillitis and pharyngitis. Am J Med 10: 300308.
    [Google Scholar]
  23. Campbell F, Strang C, Ferguson N, Cori A, Jombart T, 2018. When are pathogen genome sequences informative of transmission events? PLoS Pathog 14: e1006885.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.19-0576
Loading
/content/journals/10.4269/ajtmh.19-0576
Loading

Data & Media loading...

  • Received : 02 Aug 2019
  • Accepted : 08 Dec 2019
  • Published online : 06 Apr 2020
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error