Plague: Disease, management, and recognition of act of terrorism

Plague is a zoonosis caused by Yersinia pestis that classically presents in bubonic, septicemic, or pneumonic form. Aerosolized Y pestis is the most likely method used in a bioterrorist attack, which can lead to a rapidly fatal pneumonic plague. Plague should be suspected when the clinical picture is consistent and bipolar staining gram-negative rods are present. Because vaccines are not currently available in the United States, pre-exposure and postexposure chemoprophylaxis should be used. Recent advances in genomic research on Y pestis should help in better understanding the epidemiology and the development of rapid diagnostic tests, and safer and more effective vaccines.