Madagascar 2011: Pneumonic plague cases/outbreaks

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http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,87164

Archive Number 20110220.0555
Published Date 20-FEB-2011
Subject PRO/AH/EDR> Plague, pneumonic - Madagascar: (Antsiranana) RFI


PLAGUE, PNEUMONIC - MADAGASCAR: (ANTSIRANANA) REQUEST FOR INFORMATION
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Date: Sun 20 Feb 2011
Source: La Tribune online, Diego Suarez, Madagascar
[In French, trans. JW, edited]
<http://latribune.cyber-diego.com/actualites/299-epidemie-de-peste-dans-le-nord-de-madagascar.html>


An epidemic of pneumonic plague has been raging for weeks in the
northern region of Madagascar, mainly around Ambilobe. There are
already 16 deaths attributed to this epidemic.

This statement of the "Chancellery detached from France" in Diego
Suarez is based on information from the referring doctor's office,
Dr. Anant Govinjee:
"An epidemic of pneumonic plague occurred in the region between Diana
and Ambilobe Ambanja, specifically east of Beramanja (65 km). The
first suspected case appeared 27 Jan 2011, followed by a first death
on 29 Jan 2011. The death toll stands at 16.

A team of the Ministry of Health of Diego Suarez and a team from the
Pasteur Institute are on site. Preventive measures have been taken and
mass chemoprophylaxis is being carried out.

--
Communicated by:
HealthMap Alerts via ProMED-mail
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[Primary pneumonic plague (one 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 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. -
Mod. LL]

[The authorities are implementing rat control in the area, but unless
they carry out flea control first, that will just make matters worse,
because infectious fleas will jump from dying rats to humans. The
epidemic seems to be spreading remarkably slowly for an airborne
disease, with just 16 deaths in 3 weeks for a disease that is
"invariably fatal unless antimicrobial therapy commences within 24
hours of exposure" (actually within 48hrs).

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

http://translate.google.com/transla...rev=/search?q=peste+beramanja&hl=en&prmd=ivns

Plague Ambilobe: The list of victims is growing
?crit par Franck Raj Written by Franck Raj

The plague continues to claim victims in Ambilobe. Thus, last Monday there were still two more deaths in one of the rural commune of Ambarakaraka and the other in that of Manambato, bringing the death toll to 16. To curb the spread of the epidemic, local authorities have established a roadblock in the town of Health Beramanja, but also to the fork in the road that leads to Manambato. Officers from the Ministry of Health, police and the gendarmerie and the districts involved in moving the dam health. The goal is to install the distribution of drugs but also to protect persons traveling in the above municipalities.

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

http://amoron-i-mania.com/mg/index....e-fait-14-victimes&catid=36:societe&Itemid=62

Ambilobe: The plague caused 14 victims

Written by Franck Raj

A strange epidemic occurred since the beginning of this month Ambilobe. She is already 14 victims until we talk. After finding doctors, this is a new form of plague. Faced with the possibility of developing a pandemic, local authorities have created a cell of awareness conducted by the district, the Department of Public Health and the Armed Forces.

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

http://www.moov.mg/actualiteNationale.php?articleId=652691

Ambilobe: the plague?

(08-02-2011) - Some of the capital daily wrote in its Tuesday editions of the existence of 16 deaths in a rural village in the district of Ambilobe since 27 January.

From a source with Ambilobe, suspicion of plague in this flat area north of the island. "Here, there is much talk of the plague!" Said a resident of this area.

According to these newspapers, one reported 14 dead and another 16 deaths, the first case was reported on January 27. Le 29 janvier, la maladie a fait 3 morts. On 29 January, the disease has killed three. And since then the number of deaths is increasing. Two other people died of the disease Monday. Health authorities are already on site and made [samples]. The samples were sent to the Pasteur Institute in Antananarivo. And test results are eagerly awaited.
"Dams are medical already in place to give drugs to people entering or leaving the village," according to our source still.
Pending the outcome, health authorities have also sensitized the public to directly consult the health centers in case of chronic cough or high fever.

Remember that [plague] can be bubonic or [pneumonic]. Bubonic plague is due to the bite of a flea from a rat or a rodent infected. The plague broke out first in rodents dying in large scale. Fleas losing their hosts seek other sources of blood, and infect humans and pets. Consumptive fever or lung can be transmitted through the air by a patient suffering from bubonic plague

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

http://www.moov.mg/actualiteNationale.php?articleId=652861

French to English translation
Ambarakaraka-Ambilobe: that the plague!
(09-02-2011) - Cases of suspected plague have occurred in the town of Ambarakaraka in Ambilobe and killed 16 people since January 27 last.
The latest cases of plague have been confirmed. "There is no doubt that the plague is confirmed," said an official at the Ministry of Health and Family Planning, without giving further details on the results of Analyses conducted by the Institute Pasteur of Antananarivo.

The first case was reported on January 27 last in this county. On 29 January, the disease has already killed three. And the number of deaths has increased day by day until reaching 16 deaths Monday. Samples were taken and analyzed in Antananarivo. Medical dams have already been put in place to give drugs to people entering or leaving the village, always according to our source. "This is like the antibiotic doxycycline and tetracycline," said our source.

The current season with dirt to allow rats out of their dens. Recall that the bubonic plague may or consumptive. Bubonic plague is caused by the bite of a flea from a rat or a rodent infected. The plague broke out first in rodents dying in large scale. Fleas losing their hosts seek other sources of blood, and infect humans and pets. Consumptive fever or lung can be transmitted through the air by a patient suffering from bubonic plague.

In 1999, roadblocks were health already in place on the national road linking Antananarivo 7 south of the country via Antsirabe. Dams which were distributed to doxycycline at all passenger vehicles. And it was to prevent an epidemic of cholera which has killed 1300.


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Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Apparently, we're coming to this story a bit late. Fourteen deaths had occurred by February 8th, and two more occurred on the 14th (although they could have actually occurred on the 7th; the reporting is unclear). If the current reporting is accurate, then the fact that there may have been no new deaths in at least six days is encouraging (although it might be due to delayed reporting).

There is no reason to think this is anything but an actual outbreak of pneumonic plague.

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Apparently, plague is severly endemic in the region. Besides this outbreak, there have also been five (bubonic?) plague fatalities in Madagascar in 2011.

http://www.wienerzeitung.at/DesktopDefault.aspx?TabID=3941&Alias=wzo&cob=543063

Antananarivo. Since the beginning of January in Madagascar 21 people have died of the plague. Police and health authorities have, according to the newspaper "Courrier" of Wednesday near the towns Ambilobe, Manambato Ambarakaraka and in the northwest of the island nation set up roadblocks to prevent further spread of the disease.
But this region had counted 16 plague victims. Medical teams in the isolated locations distributes the drug. The highly contagious infectious disease can be effectively treated with antibiotics.

In early January were east near the town of the capital Antananarivo Ambohimangakely reported five victims of the plague. In the rainy season in Madagascar there are always cases for many years. The main carriers of the bacteria are ubiquitous rats, the slums of the cities that populate the most open sewers and the countless unauthorized dumps.

Plague is transmitted primarily through the bite of rat fleas to humans. 2009, on the island in southeast Africa 18 people died of the plague. (APA)

 

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Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,87177

Archive Number 20110221.0563
Published Date 21-FEB-2011
Subject PRO/AH/EDR> Plague, pneumonic - Madagascar (02): (AS) Institut Pasteur report


PLAGUE, PNEUMONIC - MADAGASCAR (02): (ANTSIRANANA) INSTITUT PASTEUR REPORT
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Date: Mon 14 Feb 2011
From: Jean-Michel Heraud <jmheraud@pasteur.mg> [edited]

[We apologize for the one week delay in posting this communication.
There were technical difficulties and a number of emails were
misdirected. - Mod. DK]

[Re: Plague, pneumonic - Madagascar: (Antsiranana) RFI 20110220.0555]
----------------------------------------------------------------------
On Thu 10 Feb 2011, it was reported to Institut Pasteur from
Madagascar that 14 people had died from a very contagious disease.
According local health staff, syndromes of patients were likely to be
pneumonic plague. To our knowledge, only 2 out of 7 sputum samples
have given positive results on rapid test strips.

The initial cases appeared in a remote village located 45 km [28 mi]
from Ambilobe (administrative region of Sava [Antsiranana province],
in the north of Madagascar). Other suspected cases have been reported
in other villages closer to Ambilobe. On Fri 11 Feb 2011, bubonic
plague suspected cases have been reported in Ambaja, another city
located in the south of villages where the 1st cases were reported.

Madagascar is an endemic region for plague but cases are generally
located in the Central Highlands. The current outbreak is occurring
in a region were plague is not endemic. It is not clear for now if
the index cases was a patient who came from an endemic area
incubating the disease or in its earlier stages and developed
pneumonic symptoms on arrival. Over the last year the regions of
Ambaja and Ambilobe experienced increasing numbers of gem seekers.
Indeed, sapphires have been recently found between Ambaja and Ambilobe.

Institut Pasteur from Madagascar (IPM) sent on Sunday morning, 13 Feb
2011, staffs by plane in order to collect specimens. A joint team
including MoH (Division of Emergency and Response against Disease,
DULMN) is going on site for investigation.

--
Dr. Jean-Michel Heraud
Chief, Virology Unit
Institut Pasteur de Madagascar
Antananarivo, Madagascar
<jmheraud@pasteur.mg>

[ProMED-mail thanks Dr. Heraud for this report. It may never be
clearly determined how _Yersinia pestis_ was introduced into this
area of northern Madagascar where plague has not been endemic. - Mod. LL]

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

http://www.lexpressmada.com/epidemi...neuf-victimes-de-la-peste-en-une-semaine.html

French to English translation
Epidemic
Nineteen victims of the plague in a week

Send to a friend Print rains, lack of sanitation and insecurity plague in the lead quartiers.La plague claimed several lives in a few days in various locations of the Big Island. Climate change and the precariousness of health appear to be the origins of this epidemic.

The plague has hit hard in February. Thus, 18 people died from the disease in less than a week in different localities of the Big Island.
"14 people were victims of pneumonic plague in a village located 65 km from the district Ambilobe, of the 19 infected by the end of the week," recalls Jean de Dieu Marie Rakotomanga, Secretary General of the Ministry of Health. But the victims of this epidemic have not arrested in the region of Diana, north-west. "Three people were killed as the pneumonic plague in the district of the four infected Brickaville weekend," continued the secretary general of the Ministry of Health. The disease was also another victim at the door of the Capital. "A girl of ten years has died of bubonic plague, the last week in Ambohimangakely," said Jean de Dieu Marie always Rakotomanga.
In this way, the plague is now decentralized. "For districts Ambilobe Brickaville and are not part of the triangle of the plague outbreak," said Secretary General of the Ministry of Health.
Inhalation
These are the districts of Tsaratanana and Mandoto and their surrounding which are the main foci of the epidemic. The main causes cited for the outbreak of plague in these areas as climate change and the precarious health. "The duration of the rainy season is reduced to only a few weeks instead of four months. Thus, the weather promotes the movement of rats, "says Nirina Yollande Raoelina, Director in the Directorate of emergencies and the fight against diseases (DULMD).
Also, rats are more in touch with society because of climate change combined with unsanitary conditions. Because waste is the first food from these rats on the prowl.
But ignorance of the first signs of the disease also delays the processing of causing casualties. "The first victim did not alert the village in the district of Ambilobe. Because the villagers have alerted doctors only after three people in one family died of the plague. Yet the disease has infected many people because the germ is spread by respiratory route, "said Jean de Dieu Marie Rakotomanga.
Ambohimangakely in common, the family of the girl found fever and cough as early as the flu. "So the treatment is too late despite our intervention. In addition, the small has refused to go to hospital if his mother has not yet come, "complains Minoso Saholy Razafindravao, MD Department Inspector District Public Health Avaradrano Antananarivo.
Vonjy Radasimalala
Tuesday, February 22, 2011
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Re: Madagascar: Outbreak of pneumonic plague - at least 23 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 23 deaths

http://www.madagascar-tribune.com/La-peste-fait-23-morts,15525.html

French to English translation
The plague killed 23 people
Wednesday, February 23, 2011
Bubonic plague has hit where it was least expected little. 15 people have died of this disease in parts of the enclave district of Ambilobe. Other deaths occurred on the side of Brickaville. The populations of the villages concerned, hardly familiar with the symptoms of the disease, have been slow to reach out to medical centers and the appropriate means to fight against this epidemic have been slow to reach them.

In total, 45 cases of plague have been detected in Madagascar since the beginning of the year. 23 people have succumbed to the disease.

Almost every year, plague occurs in Madagascar. The episodes take place between October and April, when combine the effects of the rainy season and the lean period in terms of food: the hygiene conditions deteriorate and rats begin to enter the villages.

The presence of lymph nodes under the armpit, in the crotch or under the neck to get them to seek help immediately. The best prevention is hygiene and the fight against rats. However, they should not be killed with pesticides, but captured alive using snares, then burned to remove the fleas they carry

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

http://www.midi-madagasikara.mg/ind...-a-tue-trois-autres-personnes&catid=3:societe

Health: The plague has killed three other people
Wednesday, February 23, 2011 0:00
Despite calls for the cleanliness awareness launched by the Ministry of Health, unhealthy continues to plague the country. The epidemic of plague and people watching, and this, everywhere. The department has already conducted a course in rodent Ambohimangakely, but new deaths have been recorded a few miles from Brickaville. Thus, between Toamasina and Brickaville, several workers working on a construction site. A few days ago, 9 people became ill and were directly discharged into a health center based in Antananarivo. Two of them died and were brought back and buried Faratsiho. But another victim died, and after analysis of the hospital, doctors testified that the man died as a result of the contraction of pneumonic plague. The latter was buried at Anjanahary. The other victims remain under medical supervision at the CSB II Andoharanofotsy. These new plague cases concern the public, particularly as preventive measures in some areas. From the department, doctors point out that screening and care are free from plague, but mostly it's a disease that can be completely cured if the patient is supported in time. Only acts of prevention, cleanliness at home and in his workplace.

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Apparently, this is ongoing...

http://www.linfo.re/-Sante,422-/Une-epidemie-de-peste-redoutee-a-Madagascar

French to English translation
A plague epidemic feared in Madagascar
Published: Wednesday, March 16, 2011 at 16:25 - Updated: 03/16/2011 16:26
See the photo Facilitating visualisationFermer-Madagascar-Indian Ocean outbreak of plague redout?ePhoto 1 / 1

-------------------------------------------------- ------------------------------
March 14, the death of a girl suffering from pneumonic plague in the rural community of Ambohimangakely Analamanga in the region has caused social unrest in the community. The authorities, fearing an epidemic, will take the necessary measures for those who refuse disinfection.



A social unrest erupted a little unusual in the rural commune of Ambohimangakely. Indeed, following the death of a young girl suffering from pneumonic plague, the administrative authorities of that community and some residents clashed.


Some people refuse to go into the basic health centers and do not want the council official disinfect their surroundings. A situation that does not please the mayor of the town, Dr. Naina Andrianarison. "The town continues to sensitization through the great public households. It picks up trash three times a day, we did a sweep. With the Municipal Bureau of Health (BMH) in Antananarivo and the Department of Health, it was spraying insecticide in some households but are committed to what ever you do it at home, "he said.


On the other hand, people defend themselves against the polemics. "You start getting tired of this situation. If the fever is really there, we all already achieved, "says Lise Razanany, a resident. He added: "Whenever one is sick, the doctors ask if this is not the plague, if it cleans well around us, if we use insecticides and everything."


Faced with this distressing situation, the authorities will take adequate measures for those who do not cooperate. "For those who do not disinfect, they are asked to sign an undertaking as those responsible for the spread of plague in their locality or in that of their neighborhood," said Mamy Andrianavony, chief medical officer in the center of basic health the municipality.

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,87809

Archive Number 20110401.1006
Published Date 01-APR-2011
Subject PRO/AH/EDR> Plague, pneumonic - Madagascar (04)

PLAGUE, PNEUMONIC - MADAGASCAR (04)
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Date: Thu 31 Mar 2011
Source: tagesschau.de [in German, machine trans., edited]
<http://www.tagesschau.de/ausland/pest100.html>


In Madagascar, the death toll from plague is rising. According to
official figures as 60 people died of the infectious disease. About
200 people were also infected with the plague, the health authority
said in Antananarivo. "We are very concerned," said Bruno Maes from
the UN children's agency UNICEF in the capital of Madagascar over the
rapid spread of the plague.

Meanwhile, almost all regions of the island nation in southeast
Africa are affected by the disease. Plague is transmitted primarily
through the bite of rat fleas to humans. Many rats flee in the rainy
season and periodic flooding from November to April in the villages
and towns.

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

http://eafr.promedmail.org/

Plague kills 60 people in Madagascar
------------------------------------
In Madagascar, the death toll is rising due to rampant plague. According to official figures, 60 people have died of the highly contagious infectious disease since the beginning of the outbreak. About 200 people have been infected with plague, said the health authority in Antananarivo. "We are very concerned," said Bruno Maes from the UN children's agency UNICEF in the capital of Madagascar over the rapid spread of the plague. "In many cases, the infected people report late to the doctor, for fear that they cannot afford to pay for the drugs," said doctors.

Meanwhile, almost all regions of the island nation in southeast Africa are affected by the disease. Plague is transmitted primarily through the bite of rat fleas to humans. Many rats flee to villages and towns in the rainy season and during periodic flooding from November to April. Previously it was assumed that the disease could be treated effectively with antibiotics but there are now initial reports that the seemingly simple medical treatment of the disease no longer works. [No explanation of this is provided? Has the bacterium developed resistance to antibiotics? IS this due to delay in treatment? - alert]

Health care in Madagascar deteriorated rapidly since the military coup. The residents live in very poor conditions. According to UN calculations, only one in two has access to clean drinking water. According to UNESCO, every year more than 70 000 children die before their 5th birthday from preventable diseases such as diarrhea, respiratory infections, and malaria.

 

[Giuseppe]

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

Tetracyclines are among the antibiotics active against Yersinia Pestis.

Resistance appears to date to be not common but with bacteria we cannot be sure until appropriate laboratory tests excluded this unwelcomed feature.

It is worth to note that the pneumonic plague is a rapidly evolving condition and if the treatment is not started as soon as possible, the likelihood of a fatal outcome increases.

If the therapy delay is prolonged the mortality could be very high.

 

[JimO]

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

Re: Madagascar: Outbreak of pneumonic plague - at least 16 deaths

That can't be good.

http://eafr.promedmail.org/

Plague kills 60 people in Madagascar
------------------------------------
Previously it was assumed that the disease could be treated effectively with antibiotics but there are now initial reports that the seemingly simple medical treatment of the disease no longer works. [No explanation of this is provided? Has the bacterium developed resistance to antibiotics? IS this due to delay in treatment? - alert]

 

[Giuseppe]

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

World Health Organization, Plague Manual, Treatment: http://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf

 

[Giuseppe]

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

World Health Organization, Plague Manual, Preface: http://www.who.int/csr/resources/publications/plague/whocdscsredc992a.pdf

PREFACE

One of the oldest identifiable diseases known to man, plague remains endemic in many natural foci around the world. It is widely distributed in the tropics and subtropics and in warmer areas of temperate countries.

Essentially a disease of wild rodents, plague is spread from one rodent to another by flea ectoparasites and to humans either by the bite of infected fleas or when handling infected hosts. Recent outbreaks have shown that plague may reoccur in areas that have long remained silent.

Untreated, mortality - particularly from pneumonic plague - may reach high levels. When rapidly diagnosed and promptly treated, plague may be successfully managed with antibiotics such as streptomycin and tetracycline, reducing mortality from 60% to less than 15%.

However, the recent appearance in Madagascar of a strain of Yersinia pestis showing multiresistance to antibiotics is a matter of much concern and highlights the necessity for effective surveillance of the disease (1).

(...)
-
-----

 

[Giuseppe]

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

Source: Antimicrob Agents Chemother, http://aac.asm.org/cgi/content/full/50/10/3233

Antimicrobial Agents and Chemotherapy, October 2006, p. 3233-3236, Vol. 50, No. 10 - 0066-4804/06/$08.00+0 doi:10.1128/AAC.00306-06
Copyright ? 2006, American Society for Microbiology. All Rights Reserved.

MINIREVIEW

Resistance of Yersinia pestis to Antimicrobial Agents

Marc Galimand,1* Elisabeth Carniel,2 and Patrice Courvalin1

Unit? des Agents Antibact?riens, and Yersinia Research Unit, National Reference Laboratory,1 WHO Collaborating Center for Yersinia, Institut Pasteur, Paris, France2

(...)

In 1995, high-level resistance to antimicrobial agents, includingto all of the drugs recommended for plague prophylaxis and therapy,was observed in a clinical isolate of Y. pestis (12). This strain(17/95) was isolated in the Ambalavao district of Madagascarfrom a 16-year-old male presenting with symptoms of bubonicplague. The second strain (16/95) (13) with high-level resistanceto streptomycin was isolated the same year in the Ampitana districtof Madagascar. This isolate was obtained from a 14-year-oldpatient presenting with bubonic plague. Both patients recoveredafter antibiotic therapy consisting of intramuscular injectionsof streptomycin (2 g per day for 4 days) and oral administrationof trimethoprim-sulfamethoxazole (2 g per day for 10 days). Yersinia pestis 17/95. Strain 17/95 exhibited high-level resistance to eight antimicrobialagents, including not only those recommended for therapy (streptomycin,chloramphenicol, and tetracycline) and prophylaxis (sulfonamideand tetracycline) of plague but also drugs that may have representedalternatives to classical therapy, such as ampicillin, kanamycin,and spectinomycin. Resistance to ampicillin, chloramphenicol,kanamycin, sulfonamide, and streptomycin-spectinomycin was dueto the production of a TEM-1 penicillinase (bla_TEM-1), a typeI chloramphenicol acetyltransferase (catI), a type I 3'-O-aminoglycosidephosphotransferase [aph(3')-I], a drug-resistant dihydropteroatesynthase (sul1), and a 3"-9-O-aminoglycoside adenylyltransferase(ant3"9), respectively. Resistance to tetracycline was by efflux[tet(D)]. The isolate remained susceptible to cephalosporins,other aminoglycosides, quinolones, and trimethoprim. Most likely,the activity of trimethoprim, despite lack of synergism withsulfonamide, accounted for the patient's recovery.

(...)

 

[alert]

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

Re: Madagascar: Outbreak of pneumonic plague - at least 60 deaths - reports that antibiotics are not working

It appears this is ongoing...

http://promedmail.org/pls/apex/f?p=..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,90691

Archive Number 20111014.3088
Published Date 14-OCT-2011
Subject PRO/AH/EDR> Plague, pneumonic - Madagascar (05): (AV)

PLAGUE, PNEUMONIC - MADAGASCAR (05): (ANTANANARIVO)
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Date: Tue 12 Oct 2011
Source: Afriquinfos [machine transl.] [edited]
http://www.afriquinfos.com/articles/2011/10/11/brevesdafrique-188649.asp


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.

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[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. -
Mod.LL]

[The interactive HealthMap/ProMED map for Madagascar is available at:
<http://healthmap.org/r/1kSe> - CopyEd.EJP]