[The plague, possible bioterrorist act].
PLAGUE AND BIOWARFARE: Plague is an infection caused by Yersinia pestis. This is a major agent that might be used as a biological weapon. If the bacteria is sprayed, the most frequent clinical form would be pneumonia. If contaminated fleas were used, the bubonic and septicaemic forms would be those observed. Suspicious context A biowarfare act by spraying Y pestis must be suspected when a patient without any risk factors presents with a primary pulmonary form of the disease in a non endemic area.
All the patients presenting with a pulmonary form of plague must be hospitalised and isolated in de-pressurised room, at least for the first three days of antibiotherapy. For the other clinical forms, patients must isolated during the first 48 hours of treatment. Treatment must be initiated as rapidly as possible. Strains of Y. pestis are usually sensitive to many antibiotics (streptomycin, gentamicin, doxycycline, ciprofloxacin, chloramphenicol, sulfadiazin, trimethoprime-sulfamethoxazole...).


CONCLUSIONS
In the case of contact with a spray suspected of containing the plague bacilla, doxycycline or ciprofloxacin can be prescribed. A dead cell vaccine exists, but its efficacy in terms of protection from primary pneumonia appears inadequate.
Bossi
Philippe
P
Service de maladies infectieuses et tropicales groupe hospitalier pitié-salpêtrière 47-83, Boulevard de l'hôpital, 75013 Paris-France. philippe.bossi@psl.ap-hop-paris.fr
Bricaire
François
F
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D023482:Bioterrorism / Q000517:prevention & control; D005060:Europe; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D010930:Plague / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D000900:Anti-Bacterial Agents