Published Date: 2011-10-14 19:17:52
Subject: PRO/AH/EDR> Plague, pneumonic - Madagascar (05): (AV)
Archive Number: 20111014.3088
PLAGUE, PNEUMONIC - MADAGASCAR (05): (ANTANANARIVO)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue 12 Oct 2011
Source: Afriquinfos [machine transl.] [edited]
A pneumonic plague epidemic has been declared in the district of
Miarinarivo located in the province of Antananarivo, the Malagasy
capital has reported to the local press Tuesday, 11 Oct 2011. One
person has died of this disease and 5 other persons are being treated
at the hospital.
The district of Miarinarivo and its environs are included among the 12
regions known as endemic for the disease on the island, but it was
also noted that the regions of the central highlands are the most
favorable to their development because of a higher altitude to 800
meters and a cooler temperature.
Plague reappeared in December 2010 with 5 cases including 1 death in a
village 15 km [9.3 miles] from the capital as well as 16 deaths in
Ambilobe, in the northern region of Madagascar in February 2011.
ProMED-mail from HealthMap Alerts
[Primary pneumonic plague (1 percent of natural plague presentations)
arises as a result of inhalation of plague bacilli in infectious
aerosols, such as would be produced when there are secondary pneumonic
complications in bubonic/septicemic plague.
Primary plague pneumonia has a short incubation period of 1-3 days,
after which there is sudden onset of flu-like symptoms including
fever, chills, headache, generalized body pains, weakness and chest
discomfort. A cough develops with sputum production, which may be
bloody, and increasing chest pain and difficulty in breathing. As the
disease progresses, hypoxia (low oxygen concentration in the blood)
and hemoptysis (coughing up blood) are prominent. The disease is
invariably fatal unless antimicrobial therapy commences within 24
hours of exposure.
Patients with primary pneumonic plague generate large quantities of
infectious aerosols that pose a significant risk to close contacts.
CDC guidelines identify contacts within 2 meters [6 feet] as being at
greatest risk and do not consider the organism likely to be carried
through air ducts or vents. Persons who have been in contact with
pneumonic plague patients or handling potentially infectious body
fluids or tissues without appropriate protection should receive
preventive antimicrobial therapy. The preferred antimicrobial agents
for prophylaxis are tetracyclines, quinolones, or chloramphenicol.
Madagascar was the location of the isolation of multi-antimicrobial
resistant _Y. pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et
al: Multidrug resistance in _Yersinia pestis_ mediated by a
transferable plasmid. N Engl J Med 1997;337: 677-81). The strain was
resistant to chloramphenicol, streptomycin and tetracycline but
sensitive to fluoroquinolones and trimethoprim as well as other
aminoglycosides. This was an ominous observation, however, it is not
clear if this naturally occurring strain has persisted or spread. -
[The interactive HealthMap/ProMED map for Madagascar is available at:
http://healthmap.org/r/1kSe - CopyEd.EJP]