Yersinia pestis infection natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assistant Editors-In-Chief: Esther Lee, M.A.

Overview

If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. About 14% (1 in 7) of all plague cases in the United States are fatal.

Complications

Untreated bubonic plague has a case fatality of rate 50-60%, with proper identification and prompt treatment the case fatality decreases to around 7%. Untreated septicemia or pneumonic plague is almost universally fatal if untreated early on. Even with proper therapy the latter may lead to mortality rates as high as 50%.

Since the Yersinia pestis pathogens are blood-borne, several organs can be affected, including the spleen and brain. The diffuse infection can cause an immunologic cascade to occur, leading to disseminated intravascular coagulation (DIC), which in turn results in bleeding and necrotic skin and tissue. Such a disseminated infection increases mortality to 22%.

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