Laboratory-acquired Pneumonic Plague

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Abstract
The low incidence of pneumonic plague in laboratory workers handling Pasteurella pestis is noteworthy. This report describes a case and reviews other reported cases acquired in a like manner. The probable exposure occurred 5 days previously, the usual incubation period for natural epidemics. The resulting illness was comparable to naturally-occurring pneumonic plague and was characterized by the abrupt onset of a severely febrile disease with rapidly progressing toxicity. Pleuritic chest pain and a harassing, nonproductive cough were present early. The initial stages of pneumonic plague and the more common acute bacterial pneumonias have many common characteristics. Examination of the initial sputum by Gram stain is the only reliable tool for early differential diagnosis. In plague, appropriate antibiotics within the first 24 hours are imperative if severe morbidity or death is to be prevented. Either a broad spectrum antibiotic or streptomycin is effective. This patient was started on antibiotics within the initial 24 hours of illness. The fever and toxicity were controlled within 36 hours, and convalescence was uneventful except for a mild temperature elevation on the 5th day. It is suggested that this represents an in vivo antigen-antibody response rather than a secondary infection. The earliest detectable change on serially collected sera was a rise in opsonocytophagocytic index followed by the appearance of a precipitin band against Fraction I.