Materiały źródłowe

• #1 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Begin appropriate therapy as soon as plague is suspected. […] Patients can be treated with intravenous or oral antimicrobials, depending on severity of illness and other clinical factors. […] The decision to initiate antibiotic therapy for plague should be made based on clinical signs and symptoms and a careful patient history. […] Gentamicin and fluoroquinolones are first-line treatments in the United States. […] Duration of treatment is 10 to 14 days, but treatment can be extended for patients with ongoing fever or other concerning signs. […] The regimens listed below may need to be adjusted depending on a patient’s age, medical history, underlying health conditions, or allergies. […] Pre-exposure prophylaxis for first responders and health care providers who will care for patients with pneumonic plague is not considered necessary as long as standard and droplet precautions can be maintained.

• #1 Plague Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/235627-treatment

  Guidelines on the diagnosis and treatment of bubonic plague have been published by the Infectious Diseases Society of America (IDSA) (see Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America). […] All patients with suspected plague and signs of pneumonia should be placed in strict respiratory isolation for 48-72 hours after antibiotic therapy is initiated and kept there until pneumonia has been ruled out or until sputum culture has shown negative findings. […] Report patients thought to have plague to the local health department and to the WHO. […] Alert laboratory personnel to the possibility of the diagnosis of plague. All fluid specimens must be handled with care to prevent aerosolization of the infected fluids. Gowns, gloves, and masks should be worn at all times, and strict infection control is of utmost importance.

• #1 Controlling Spread of Plague | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/reportable-diseases/plague/controlling

  Droplet Precautions are indicated when caring for patients with plague until pneumonia is excluded and appropriate antibiotic therapy has been initiated. […] In patients with pneumonic plague, Droplet Precautions should be maintained for 72 hours after starting treatment. […] For patients with bubonic plague, Standard Precautions are advised. […] Cases with pneumonic plague are considered infectious throughout their symptomatic illness and for 72 hours following initiation of antibiotic treatment. […] People who have been in household or face-to-face contact with a case with pneumonic plague during the infectious period should be educated regarding signs and symptoms and recommended prophylaxis, and referred to their healthcare provider for antibiotic prophylaxis. […] If contacts of a pneumonic plague case are unable to receive antibiotic prophylaxis, they should be placed under a strict quarantine for a 7-day period.

• #1

  https://journals.lww.com/nursing/fulltext/2005/12000/preparing_for_a_plague_outbreak.12.aspx

  RESPONSIBLE FOR millions of deaths during the Middle Ages, plague (Yersinia pestis) no longer causes widespread epidemics due to improvements in sanitation, medical care, and antibiotic therapy. […] If treated promptly with antibiotics, plague is rarely fatal. In the United States, about 1 in 7 people (14%) dies, usually because of a delay in diagnosis and treatment. […] If a patient has suspicious signs and symptoms, question him about recent travel to areas in the United States or abroad where plague is endemic. When any form of plague is suspected, the patient should be hospitalized and placed in isolation immediately. […] Begin antibiotic therapy immediately, as ordered, with streptomycin (the antibiotic of choice), gentamicin, tetracycline, doxycycline, or chloramphenicol. […] Obtain a contact history so people in close contact with the patient can be examined and treated, if indicated. Antibiotic treatment for 7 days protects those who’ve had direct contact with an infected patient. This treatment is especially important if the patient has pneumonic plague.

• #1 Plague Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/235627-treatment

  Presumptive therapy (post-exposure prophylaxis) consists of a 7-day course of oral doxycycline and ciprofloxacin as first line treatment in adults. Treatment of an established case is usually for 10-14 days. […] In a community experiencing a pneumonic plague epidemic, individuals with a temperature of 38.5C or higher or newly onset cough should promptly receive parenteral antimicrobial therapy. […] Enlarging or fluctuant buboes require incision and drainage.

• #1 Guidance for Responding to a Plague Bioterrorism Event | Plague | CDC

  https://www.cdc.gov/plague/hcp/emergency-guidance/index.html

  Pneumonic plague is the most likely clinical manifestation following an intentional release of Yersinia pestis. […] Public health responders should work with medical providers to isolate patients with suspected or confirmed plague, monitor patient outcomes, and report data to state public health authorities. […] Plague is a very serious illness but is treatable with commonly available antimicrobials. […] During a plague emergency, your facility may be called upon to care for patients with the disease or suspected of having the disease. […] Clinicians should be trained to recognize the signs and symptoms of plague. […] All confirmed, probable, and suspected pneumonic plague case-patients should be isolated under standard and respiratory droplet precautions during the first 48 hours of antimicrobial therapy and until clinical improvement occurs, or until plague has been ruled out.

• #1

  https://www.who.int/news-room/fact-sheets/detail/plague

  Plague is a very severe disease in people, particularly in its septicaemic (systemic infection caused by circulating bacteria in bloodstream) and pneumonic forms, with a case-fatality ratio of 30% to 100% if left untreated. The pneumonic form is invariably fatal unless treated early. It is especially contagious and can trigger severe epidemics through person-to-person contact via droplets in the air. […] Untreated pneumonic plague can be rapidly fatal, so early diagnosis and treatment is essential for survival and reduction of complications. Antibiotics and supportive therapy are effective against plague if patients are diagnosed in time. Pneumonic plague can be fatal within 18 to 24 hours of disease onset if left untreated, but common antibiotics for enterobacteria (gram negative rods) can effectively cure the disease if they are delivered early.

• #1 Epidemiology, control and management of plague | PPT

  https://www.slideshare.net/RakhiYadav53/epidemiology-control-and-management-of-plague-251094399

  Plague is a zoonotic disease caused by the bacterium Yersinia pestis, which is typically transmitted between animals and humans by fleas. It has caused several pandemics throughout history, including the Black Death. The document discusses the epidemiology, transmission, types (bubonic, septicemic, pneumonic), symptoms, diagnosis, treatment, prevention and control of plague. Nursing management focuses on monitoring vital signs, providing supportive care and treatment, maintaining hygiene and educating patients. […] Nursing management focuses on monitoring vital signs, providing supportive care and treatment, maintaining hygiene and educating patients.

• #1 Epidemiology ,control and management of plague | PPT

  https://www.slideshare.net/slideshow/epidemiology-control-and-management-of-plague/251094345

  Plague nursing management focuses on monitoring vital signs, providing supportive care and treatment, maintaining hygiene and educating patients. […] Nursing management includes assessing vital signs, auscultating breath sounds, and encouraging breathing exercises. […] Health education is an essential part of any plague control programme. Emphasis must be placed on the need for the prompt reporting of dead rats and suspected human cases so that preventive measures can be taken. […] The document discusses nursing management for various diagnoses related to plague, including altered body temperature, deficient fluid volume, anxiety, risk of infection, and decreased cardiac output.

• #1 Plague – Health New Zealand | Te Whatu Ora

  https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/communicable-disease-control-manual/plague

  This guidance supports public health professionals with the prevention and management of plague species disease cases, contacts and outbreaks. […] In a health care facility, contact isolation precautions should apply to cases with suppurating buboes, and droplet isolation precautions should apply to cases with pneumonic plague. These precautions should continue at least until 48 hours of antimicrobial agents have been given and the case has clinically improved. […] Cases should be under the care of an infectious diseases physician. […] Advise the case and their caregivers of the nature of the disease and its mode of transmission. Educate about hygiene, especially cough hygiene, hand cleaning and the need to cover discharging buboes with a dressing. […] Advise all contacts of the incubation period and typical symptoms of plague. Encourage them to seek early medical attention if symptoms develop.

• #1 Plague (Yersinia pestis) Precautions | Texas DSHS

  https://www.dshs.texas.gov/notifiable-conditions/zoonosis-control/zoonosis-control-diseases-and-conditions/plague-yersinia-pestis/precautions

  Standard Precautions include the major features of Blood and Body Fluid Precautions (designed to reduce the risk of transmission of bloodborne pathogens) and BSI (designed to reduce the risk of transmission of pathogens from moist body substances) and applies them to all patients receiving care in hospitals, regardless of their diagnosis or presumed infection status. Standard Precautions apply to 1) blood; 2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood; 3) nonintact skin; and 4) mucous membranes. These are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals. […] Wear gloves (clean, non-sterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and non-intact skin. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching non contaminated items and environmental surfaces, and before going to another patient, and wash hands immediately to avoid transfer of microorganisms to other patients or environments.

• #1 Plague Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/plague

  Plague is treated with antibiotics. People with plague need to be treated right away. Treatment should be given if plague is suspected, even before test results come back. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases. […] People with pneumonic plague must be kept away from other patients and isolation procedures will be followed in the hospital. People who have had close contact with anyone infected by pneumonic plague should be given antibiotics as a preventive measure and watched carefully.

• #1 Plague | Washington State Department of Health

  https://doh.wa.gov/public-health-provider-resources/notifiable-conditions/plague

  Plague causes three main syndromes: bubonic (fever, headache, nausea and unilateral lymph node swelling); septicemic (bacteremia and multi-organ system failure); and pneumonic (pneumonia). A patient may have several syndromes. About 11% of plague cases in the United States are fatal. Treatment is with antibiotics and supportive care. […] To assist in the diagnosis and treatment of cases […] To identify potentially exposed close contacts, health care workers and laboratory personnel and to provide counseling […] To identify sources of transmission (e.g., wild rodents or other animals) and to prevent further transmission from such sources.

• #1 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  Plague is treatable with antimicrobials and supportive care. Early recognition and administration of effective antimicrobials are key to saving lives. […] Treatment recommendations for those who are elderly or immunocompromised are the same as those for adults; however, these patients may experience decreased glomerular filtration rate or polypharmacy, and clinicians should adjust treatment as necessary. […] Because plague has a high case-fatality rate, the CDC recommends antimicrobial treatment and prophylaxis for affected pregnant individuals even if antimicrobial treatment carries risk to the fetus. Fetal safety concerns should not prevent access to rapid treatment or prophylaxis for pregnant women during a plague outbreak. […] Caretakers should wear a mask in addition to taking standard precautions, as well as wear eye protection and a face shield if splashing is likely.

• #1 Plague: Recognition, Treatment, and Prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5744195/

  Plague is caused by Yersinia pestis and is not commonly encountered in clinics, although natural plague foci are widely distributed around the world. […] This review intends to provide practical information for clinical staff to recognize plague early and provide effective treatment and prevention. […] The keys to the successful treatment of plague are early recognition and timely administration of effective antibiotics. If the administration of effective antibiotics and antishock therapies are delayed by more than 24 h, it will usually be fatal for the patients. […] For plague treatment, in addition to antibiotic administration, supportive therapy for severe symptoms, such as shock, should not be neglected. […] Bubonic plague patients without secondary pneumonic and septicemic plague have a very low risk of spreading plague to close contacts. However, a patient with secondary or primary pneumonic plague can transmit Y. pestis to close contacts through coughing respiratory droplets.

• #2 Guidance for Responding to a Plague Bioterrorism Event | Plague | CDC

  https://www.cdc.gov/plague/hcp/emergency-guidance/index.html

  Plague is a very serious illness but is treatable with commonly available antimicrobials. Early treatment of plague is essential. […] To reduce the chance of death, antimicrobials should be given within 24 hours of symptom onset. […] In addition to providing medical care to the patient, consider other ways to support the patient’s general well-being. […] Healthcare and laboratory staff at potentially high risk for exposure during response activities should follow all standard and droplet precautions and use appropriate personal protective equipment (PPE). […] Following a bioterrorism attack, healthcare responders who have had close, sustained contact with patients sick with pneumonic plague while not wearing appropriate PPE should receive postexposure prophylaxis. […] Plague is a serious illness but treatable with commonly available antimicrobials. Early recognition and treatment of plague is essential.

• #2

  https://www.who.int/news-room/fact-sheets/detail/plague

  Plague is a very severe disease in people, particularly in its septicaemic (systemic infection caused by circulating bacteria in bloodstream) and pneumonic forms, with a case-fatality ratio of 30% to 100% if left untreated. The pneumonic form is invariably fatal unless treated early. It is especially contagious and can trigger severe epidemics through person-to-person contact via droplets in the air. […] Untreated pneumonic plague can be rapidly fatal, so early diagnosis and treatment is essential for survival and reduction of complications. Antibiotics and supportive therapy are effective against plague if patients are diagnosed in time. Pneumonic plague can be fatal within 18 to 24 hours of disease onset if left untreated, but common antibiotics for enterobacteria (gram negative rods) can effectively cure the disease if they are delivered early.

• #2 Controlling Spread of Plague | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/reportable-diseases/plague/controlling

  Droplet Precautions are indicated when caring for patients with plague until pneumonia is excluded and appropriate antibiotic therapy has been initiated. […] In patients with pneumonic plague, Droplet Precautions should be maintained for 72 hours after starting treatment. […] For patients with bubonic plague, Standard Precautions are advised. […] Cases with pneumonic plague are considered infectious throughout their symptomatic illness and for 72 hours following initiation of antibiotic treatment. […] People who have been in household or face-to-face contact with a case with pneumonic plague during the infectious period should be educated regarding signs and symptoms and recommended prophylaxis, and referred to their healthcare provider for antibiotic prophylaxis. […] If contacts of a pneumonic plague case are unable to receive antibiotic prophylaxis, they should be placed under a strict quarantine for a 7-day period.

• #2 Plague | Queensland Health

  https://www.health.qld.gov.au/cdcg/index/plague

  For patients with pneumonic plague: Droplet transmission-based precautions in conjunction to standard precautions are required for patients with pneumonic plague. The patients should be placed in a single room ideally with negative pressure. Most patients are likely to remain infectious for 48-72 hours after commencing appropriate antibiotic treatment and there has been a favourable clinical response. […] Confirmed cases of pneumonic plague should be kept under droplet precautions until sputum cultures are negative. […] Cases should be investigated and treated under the supervision of an Infectious Diseases Physician. Recommended antibiotic treatment includes gentamicin, doxycycline or ciprofloxacin. All are highly effective if used early. […] Close contacts should be strongly recommended to take appropriate antibiotic prophylaxis for seven days. […] A single case of plague constitutes an outbreak and should be considered as a public health emergency.

• #2 Plague | Queensland Health

  https://www.health.qld.gov.au/cdcg/index/plague

  Plague is an acute, life-threatening zoonosis. It is caused by the bacteria Yersinia pestis, a zoonotic bacterium usually found in small mammals, such as rodents, and their fleas. Humans are dead-end hosts. Impoverished populations living under substandard conditions are most at risk. […] Medical personnel should be aware of areas where the disease is endemic and consider the diagnosis of plague early, especially in international travellers who develop illness. […] For patients with bubonic plague (if there is no cough and their chest Xray film shows no feature of pneumonia): Standard precautions should be used for all patient interactions. Contact with infectious fluids should be avoided when managing patients with bubonic plague who do not have respiratory symptoms. Most patients are likely to remain infectious for 48-72 hours after commencing appropriate antibiotic treatment.

• #2 Plague Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/235627-treatment

  Hemodynamic monitoring and ventilatory support are performed as appropriate. […] Management of sepsis associated with plague requires aggressive intravenous hydration. Norepinephrine and other vasopressors may be required to manage hypotension and to improve hemodynamic status. […] Both the prevention of symptomatic plague and treatment of plague have been reviewed. In adults, first line treatment usually is streptomycin or gentamicin plus doxycycline with ciprofloxacin, levofloxacin, moxifloxacin or chloramphenicol as secondary choices. In children, streptomycin or gentamicin are the primary choices for treatment, with doxycycline, ciprofloxacin or chloramphenicol as secondary choices. Consultation with an infectious diseases specialist for either prophylaxis or treatment antibiotic choices is strongly recommended.

• #2 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Post-exposure prophylaxis is indicated for persons with known exposure to plague, such as close ( 6 ft), sustained contact with a patient or animal with pneumonic plague or direct contact with infected body fluids or tissues. […] Prophylaxis with a single antimicrobial agent is recommended for potentially exposed persons following a case of naturally acquired infection or intentional release of Y. pestis.

• #2 Plague Information for Health Care Providers

  https://portal.ct.gov/dph/public-health-preparedness/bioterrorism/plague-information-for-health-care-providers

  Treatment of all forms of the disease is most effective when started within 24 hours of initial symptoms. […] Plague pneumonia is often fatal if treatment is not initiated within 24 hours of the onset of symptoms. […] Physicians may be asked to obtain informed consent for administration of certain medications supplied by the National Pharmaceutical Stockpile (NPS). […] An exposed person is defined as a person who has been exposed to aerosolized Y. pestis or has been in close contact with a confirmed pneumonic plague patient. […] Household contacts and healthcare worker contacts should be considered exposed and should receive prophylaxis. […] All antibiotic therapy should continue for 7 days after the last exposure to the case. […] Decisions on antibiotic therapy should be guided by susceptibility testing.

• #2

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/plague.aspx

  Close contacts should be strongly recommended to take appropriate antibiotic prophylaxis for 7 days. […] Advise susceptible contacts (or parents/guardians) of the risk of infection, the need for close symptom surveillance, and quarantine (if required). […] Close contacts receiving appropriate chemoprophylaxis should be placed under daily symptom surveillance for 7 days but do not require quarantine.

• #2 Controlling Spread of Plague | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/reportable-diseases/plague/controlling

  Bubonic plague is generally not transmitted person-to-person. Quarantine would generally not be required. […] When handling the bubo aspirate and blood, laboratory personnel must use gloves and care to avoid aerosolization of these infected fluids. […] Additionally, a Y. pestis vaccine is recommended for persons whose occupations put them at high risk for exposure to Y. pestis or plague-infected rodents. […] Also, vaccine may be considered for persons traveling to, or residing in, areas with epizootic or epidemic plague.

• #2 Plague (Yersinia pestis) Precautions | Texas DSHS

  https://www.dshs.texas.gov/notifiable-conditions/zoonosis-control/zoonosis-control-diseases-and-conditions/plague-yersinia-pestis/precautions

  Wear a mask and eye protection or a face shield to protect mucous membranes during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. […] Handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. […] Place a patient who contaminates the environment or who does not (or cannot be expected to) assist in maintaining appropriate hygiene or environmental control in a private room. If a private room is not available, consult with infection control professionals regarding patient placement or other alternatives. […] In addition to Standard Precautions, use Contact Precautions, or the equivalent, for specified patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct contact with the patient (hand or skin-to-skin contact that occurs when performing patient-care activities that require touching the patients dry skin) or indirect contact with environmental surfaces or patient-care items in the patients environment.

• #2 Plague – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549855/

  Given the pathogenicity of Y. pestis, patients with plague are likely to be ill-appearing on presentation and may present to any healthcare access point. The healthcare team should attempt to recognize the characteristic clinical signs and elicit the travel history and/or exposure to help make the clinical diagnosis and begin treatment. […] Recommendations for the care of people with plague include: Droplet precautions for 48 hours following the initiation of antibiotics. […] An interprofessional team approach to care of plague victims will result in the best outcomes.

Zobacz więcej