title: Plague in China 2014-All sporadic case report of pneumonic plague.
abstract: BACKGROUND
  Yersinia pestis is the pathogen of the plague and caused three pandemics worldwide. Pneumonic plague is rarer than bubonic and septicemic plague. We report detailed clinical and pathogenic data for all the three sporadic cases of pneumonic plagues in China in 2014.
  
  
  METHODS
  All the three patients are herders in Gansu province of China. They were all infected by Yersinia pestis and displayed in the form of pneumonic plague respectively without related. We tested patient specimens from the upper (nasopharyngeal swabs) or the lower (sputum) respiratory tract and whole blood, plasma, and serum specimens for Yersinia pestis. All patients had fever, cough and dyspnea, and for patient 2 and 3, unconscious. Respiratory symptoms were predominant with acute respiratory failure. The chest X-ray showed signs consistent with necrotizing inflammation with multiple lobar involvements. Despite emergency treatment, all patients died of refractory multiple organ failure within 24 h after admission to hospital. All the contacts were quarantined immediately and there were no secondary cases.
  
  
  CONCLUSIONS
  Nowadays, the plague is epidemic in animals and can infect people who contact with the infected animals which may cause an epidemic in human. We think dogs maybe an intermediate vector for plague and as a source of risk for humans who are exposed to pet animals or who work professionally with canines. If a patient has been exposed to a risk factor and has fever and dyspnea, plague should be considered. People who had contact with a confirmed case should be isolated and investigated for F1 antigen analysis and receive post-exposure preventive treatment. A vaccination strategy might be useful for individuals who are occupationally exposed in areas where endemically infected reservoirs of plague-infected small mammals co-exist.
authors.affiliation: Radiology Department, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China. nancy821@126.com.
authors.forename: Yun-Fang
authors.initials: YF
authors.lastname: Li
authors.affiliation: Radiology Department, the First People's Hospital of Yumen, Gansu, China. lidebiao1@126.com.
authors.forename: De-Biao
authors.initials: DB
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology, Rehabilitation Center Hospital, of Gansu Province, Gansu, China. shaohongsheng7@126.com.
authors.forename: Hong-Sheng
authors.initials: HS
authors.lastname: Shao
authors.affiliation: Radiology Department, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China. lihongjun64@126.com.
authors.forename: Hong-Jun
authors.initials: HJ
authors.lastname: Li
authors.affiliation: Imaging Diagnostic Center, Lanzhou General Hospital, Lanzhou Command, PLA, Lanzhou, 730050, China. hanyuedong@126.com.
authors.forename: Yue-Dong
authors.initials: YD
authors.lastname: Han
mesh_terms: D000328:Adult; D002681:China; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D010930:Plague / Q000150:complications / Q000175:diagnosis*