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Laboratory
Test Criteria for Diagnosis of Plague
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SUSPECTED
PLAGUE SHOULD BE CONSIDERED IF THE FOLLOWING CONDITIONS ARE MET:
- Clinical
symptoms that are compatible with plague, i. e., fever and lymphadenopathy
in a person who resides in or recently traveled to a plague-endemic
area.
- If small
gram-negative and/or bipolar-staining coccobacilli are seen on
a smear taken from affected tissues, e.g.:
- Bubo (bubonic
plague)
- Blood (septicemic
plague)
- Tracheal/lung
aspirate (pneumonic plague)
PRESUMPTIVE
PLAGUE SHOULD BE CONSIDERED WHEN ONE OR BOTH OF THE FOLLOWING
CONDITIONS ARE MET:
- If immunofluorescence
stain of smear or material is positive for the presence of Yersinia
pestis F1 antigen.
- If only
a single serum specimen is tested and the anti-F1 antigen titer
by agglutination is >1:10.*
CONFIRMED
PLAGUE IS DIAGNOSED IF ONE OF THE FOLLOWING CONDITIONS IS
MET:
- If a culture
isolated is lysed by specific bacteriophage.
- If two serum
specimens demonstrate a four fold anti-F1 antigen titer difference
by agglutination testing.*
- If a single
serum specimen tested by agglutination has a titer of >1:128
and the patient has no known previous plague exposure or vaccination
history.*
*Agglutination
testing must be shown to be specific to Y. pestis F1 antigen
by hemagglutination inhibition.
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References:
Bibel DJ, Chen TH.
Diagnosis of plague: an analysis of the Yersin-Kitasato controversy. Bacteriol
Rev 1976;40:633-51.
Campbell GL, Dennis
DT. Plague and other Yersinia infections. In: Kasper DL, et al;
eds. Harrison’s principles of internal medicine. 14th ed. New York:
McGraw Hill, 1998:975-83.
Chu MC. Laboratory
Manual of Diagnostic Test. Geneva: World Health Organization, 2000.
Gage KL. Plague. In:
Colliers L, Balows A, Sussman M, Hausles WJ, eds. Topley and Wilson’s
microbiology and microbiological infections, vol 3. London: Edward Arnold
Press, 1998:885-903.
Gross L. How the plague
bacillus and its transmission through fleas were discovered: reminiscences
from my years at the Pasteur Institute in Paris. Proc Natl Acad Sci, USA,
1995;92:7609-11.
Kitasato S. The bacillus
of bubonic plague. Lancet 1894; 2:428-30.
Pollitzer, R. Plague.
WHO Monograph Serigraph 1954; 22:1-698.
Yersin A. La peste
bubonique à Hong Kong. Ann Inst Pasteur Paris 1894; 8:662-7.
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