Bioterrorism Agents – PlagueBioterrorism Agents – PlagueLesson 7Lesson 7

Information for VeterinariansInformation for Veterinarians

ObjectivesObjectives

• Symptoms of plague in Symptoms of plague in animalsanimals

• Public health Public health significance of plague significance of plague in animalsin animals

• Medication optionsMedication options

OverviewOverview

• Plague – acute, bacterial infection that Plague – acute, bacterial infection that affects both human and animals. Caused affects both human and animals. Caused by by Y. pestisY. pestis

• Affects both domestics and peri-domesticsAffects both domestics and peri-domestics

• Natural transmission in western USNatural transmission in western US

• Occasional outbreaks in rodentsOccasional outbreaks in rodents

• Some species do not have clinical signsSome species do not have clinical signs

Domestic CatsDomestic Cats

• Highly susceptibleHighly susceptible• Transmission to humansTransmission to humans

– Bites or scratchesBites or scratches– Infectious exudatesInfectious exudates– Inhalation of respiratory dropletsInhalation of respiratory droplets– Transport infected fleasTransport infected fleas

• 25 cat-to-human cases since 197725 cat-to-human cases since 1977– 7 in veterinarians or assistants7 in veterinarians or assistants– 5 primary pneumonic5 primary pneumonic

Dogs and UngulatesDogs and Ungulates

• DogsDogs– Can become infectedCan become infected– Sometimes clinical signsSometimes clinical signs– Greatest threat – transport of fleasGreatest threat – transport of fleas

• UngulatesUngulates– Rarely identified in USRarely identified in US– Relatively little risk to humansRelatively little risk to humans– Examine if after known plague in areaExamine if after known plague in area

Rodents, Rabbits and OthersRodents, Rabbits and Others

• Likely susceptibleLikely susceptible

• Bioterror exposure depends on where kept Bioterror exposure depends on where kept in relation to releasein relation to release

• Domestic ferrets – relatively resistantDomestic ferrets – relatively resistant

• Birds, reptiles, fish – completely resistantBirds, reptiles, fish – completely resistant

The Domestic FelineThe Domestic FelineA Detailed LookA Detailed Look

• Eidson, 1991Eidson, 1991– 53% - bubonic53% - bubonic– 8% - septicemic8% - septicemic– 10% - plague pneumonia10% - plague pneumonia– 29% - unknown, 29% - unknown,

septicemic?septicemic?

• Airborne release would Airborne release would result in primary result in primary pneumonic plague pneumonic plague among exposed catsamong exposed cats

The Domestic FelineThe Domestic FelineBubonic PlagueBubonic Plague

• Incubation – 2 to 3 daysIncubation – 2 to 3 days• SymptomsSymptoms

– 75% submandibular lymphadenitis75% submandibular lymphadenitis– Fever, lethargy, anorexia commonFever, lethargy, anorexia common– Oral lesions can be presentOral lesions can be present

• ProgressionProgression– DICDIC– Multi-organ failureMulti-organ failure– 38% of untreated cases fatal38% of untreated cases fatal

The Domestic FelineThe Domestic FelinePneumonic PlaguePneumonic Plague

• Incubation – 3 to 4 daysIncubation – 3 to 4 days

• SymptomsSymptoms– Serious, rapidly progressingSerious, rapidly progressing– FeverFever– CoughCough– Bloody sputumBloody sputum

• Significant risk to Significant risk to

owners and owners and

veterinarians!veterinarians!

Plague Management – AnimalsPlague Management – AnimalsPublic Health IssuesPublic Health Issues

• Important to collect samplesImportant to collect samples

• Keep chilled, not frozenKeep chilled, not frozen

• Notify public health veterinary surveillance Notify public health veterinary surveillance team immediatelyteam immediately– Assist with follow-up investigationsAssist with follow-up investigations– Preventive measuresPreventive measures

Laboratory Specimen CollectionLaboratory Specimen CollectionAntemortemAntemortem

• Available TestsAvailable Tests– Fluorescent antibodyFluorescent antibody– CultureCulture

• Specimens to CollectSpecimens to Collect– LesionsLesions– Serology – acute and convalescentSerology – acute and convalescent– Pharyngeal swabs – use culturettesPharyngeal swabs – use culturettes

• Obtain prior to antibioticsObtain prior to antibiotics

Laboratory Specimen CollectionLaboratory Specimen CollectionPostmortemPostmortem

• Available TestsAvailable Tests– Fluorescent antibodyFluorescent antibody– CultureCulture

• Specimens to CollectSpecimens to Collect– Lymph node aspirateLymph node aspirate– Tissue Samples – lymph node, liver, spleen, lung, Tissue Samples – lymph node, liver, spleen, lung,

long bones from decaying caracasseslong bones from decaying caracasses– Whole bloodWhole blood

• Place in clean container and keep chilledPlace in clean container and keep chilled• Do NOT use formalin or alcoholDo NOT use formalin or alcohol

Laboratory Specimen CollectionLaboratory Specimen CollectionProceduresProcedures

• Lymph node aspiratesLymph node aspirates– Be sure bubo itself is aspiratedBe sure bubo itself is aspirated– If little or no fluid, 1cc non-bacteriostatic salineIf little or no fluid, 1cc non-bacteriostatic saline

• SerologySerology– Acute and convalescentAcute and convalescent– 0.5ml at least 14 days apart0.5ml at least 14 days apart– Retrospective confirmation onlyRetrospective confirmation only

• Pharyngeal swab – use culturettesPharyngeal swab – use culturettes

Laboratory Specimen CollectionLaboratory Specimen CollectionHandlingHandling

• Keep chilled, not frozenKeep chilled, not frozen

• Submit as quickly as possibleSubmit as quickly as possible

• Request instructions from public healthRequest instructions from public health

• Leave aspirates in syringe or transfer to Leave aspirates in syringe or transfer to culturetteculturette

Plague TreatmentPlague TreatmentAnimalsAnimals

• Radiographs to check for pneumoniaRadiographs to check for pneumonia• Start antibiotics immediatelyStart antibiotics immediately• Preferred – StreptomycinPreferred – Streptomycin

• Sulfonamides can be tried if other drugs Sulfonamides can be tried if other drugs not availablenot available

GentamicinGentamicin 2-3mg/kg TID, IM or SQ2-3mg/kg TID, IM or SQ

DoxycyclineDoxycycline 5mg/kg BID, PO5mg/kg BID, PO

TetracyclineTetracycline 22mg/kg TID, PO22mg/kg TID, PO

ChloramphenicolChloramphenicol 50mg/kg BID PO50mg/kg BID PO

Infection ControlInfection ControlVeterinary ClinicVeterinary Clinic

• Maintain in isolation until improvementMaintain in isolation until improvement

• Thought to be noninfectious after 48 hrsThought to be noninfectious after 48 hrs

• Apply flea control to cat and premisesApply flea control to cat and premises

• Potential risk for humansPotential risk for humans– Pneumonic – respiratory spreadPneumonic – respiratory spread– Bubonic – contact with infectious tissues, Bubonic – contact with infectious tissues,

exudates or fleasexudates or fleas

• Cat fleas poor vectors of plagueCat fleas poor vectors of plague

Infection ControlInfection ControlVeterinary ClinicVeterinary Clinic

• Exudates and oral cavity Exudates and oral cavity infectiousinfectious

• Disinfect any material used Disinfect any material used for treatmentfor treatment

• Pneumonic plague – close Pneumonic plague – close patient contactpatient contact

• Wear mask and glovesWear mask and gloves• Well-fitted N95 rated mask Well-fitted N95 rated mask

preferred, but surgical mask preferred, but surgical mask might offer some protectionmight offer some protection

Infection ControlInfection ControlVeterinary ClinicVeterinary Clinic

• Consult public health after exposure to Consult public health after exposure to infected catinfected cat

• Get to doctor immediately if febrile illness Get to doctor immediately if febrile illness after exposureafter exposure

• Incubation in Humans – 2 to 6 Incubation in Humans – 2 to 6

days, but can be as short days, but can be as short

as one dayas one day

• Early treatment is criticalEarly treatment is critical

Infection ControlInfection ControlAnimal OwnersAnimal Owners

• Refer owners to public healthRefer owners to public health• Use following precautionsUse following precautions

– Confine pets as much as possibleConfine pets as much as possible– Apply flea controlApply flea control– Do not share sleeping area with animalsDo not share sleeping area with animals– Get any ill animals to veterinarianGet any ill animals to veterinarian

• Intentional plague release – keep all Intentional plague release – keep all animals indoorsanimals indoors

Plague Review QuestionsPlague Review QuestionsLesson 7Lesson 7

Information for VeterinariansInformation for Veterinarians

Plague Review QuestionPlague Review QuestionLesson 7, Question 1Lesson 7, Question 1

• Domestic feline patientDomestic feline patient

• Sick for several daysSick for several days

• Suspicion of plagueSuspicion of plague

What do you base your initial findings on?What do you base your initial findings on?

Plague Review QuestionPlague Review QuestionLesson 7, Question 1Lesson 7, Question 1

What do you base your initial findings on?What do you base your initial findings on?

A.A. Anorexia, oral lesions, feverAnorexia, oral lesions, fever

B.B. History of roaming, submandibular History of roaming, submandibular lymphadenitislymphadenitis

C.C. Clinic in western USClinic in western US

D.D. All of the aboveAll of the above

Plague Review QuestionPlague Review QuestionLesson 7, Question 1Lesson 7, Question 1

What do you base your initial findings on?What do you base your initial findings on?

D.D. All of the aboveAll of the above– Anorexia, oral lesions, feverAnorexia, oral lesions, fever– Roaming, submandibular lymphadenitisRoaming, submandibular lymphadenitis– Clinic in western USClinic in western US

Plague Review QuestionPlague Review QuestionLesson 7, Question 2Lesson 7, Question 2

• Domestic feline patientDomestic feline patient

• Thorough physical examThorough physical exam

• Radiographs to look for pneumoniaRadiographs to look for pneumonia

• Collection of lab samplesCollection of lab samples

What do you start your patient on?What do you start your patient on?

Plague Review QuestionPlague Review QuestionLesson 7, Question 2Lesson 7, Question 2

What do you start your patient on?What do you start your patient on?

A.A. StreptomycinStreptomycin

B.B. AmpicillinAmpicillin

C.C. AmoxicillinAmoxicillin

D.D. ClavamoxClavamox

Plague Review QuestionPlague Review QuestionLesson 7, Question 2Lesson 7, Question 2

What do you start your patient on?What do you start your patient on?

A. StreptomycinA. Streptomycin

Plague Review QuestionPlague Review QuestionLesson 7, Question 3Lesson 7, Question 3

• Domestic feline patientDomestic feline patient

• Suspected plagueSuspected plague

• Clinic is located in New JerseyClinic is located in New Jersey

What is the significance of this finding?What is the significance of this finding?

Plague Review QuestionsPlague Review QuestionsLesson 7, Question 3Lesson 7, Question 3

What is the significance of this finding?What is the significance of this finding?

A.A. It’s just an anomalyIt’s just an anomaly

B.B. One expects plague in New JerseyOne expects plague in New Jersey

C.C. Could indicate a bioterrorist eventCould indicate a bioterrorist event

D.D. Animals get sick after humans doAnimals get sick after humans do

Plague Review QuestionsPlague Review QuestionsLesson 7, Question 3Lesson 7, Question 3

What is the significance of this finding?What is the significance of this finding?

C. Could indicate a bioterrorist eventC. Could indicate a bioterrorist event