Factors Influencing Atypical Clinical Presentations during the 2017 Madagascar Pneumonic Plague Outbreak: A Prospective Cohort Study - Institut Pasteur Access content directly
Journal Articles American Journal of Tropical Medicine and Hygiene Year : 2020

Factors Influencing Atypical Clinical Presentations during the 2017 Madagascar Pneumonic Plague Outbreak: A Prospective Cohort Study

Jean-Michel Heraud
Peter Horby
  • Function : Author

Abstract

In late 2017, Madagascar experienced a large urban outbreak of pneumonic plague, the largest outbreak to date this century. During the outbreak, there were widespread reports of plague patients presenting with atypical symptoms, such as prolonged duration of illness and upper respiratory tract symptoms. Reported mortality among plague cases was also substantially lower than that reported in the literature (25% versus 50% in treated patients). A prospective multicenter observational study was carried out to investigate potential reasons for these atypical presentations. Few subjects among our cohort had confirmed or probable plague, suggesting that, in part, there was overdiagnosis of plague cases by clinicians. However, 35% subjects reported using an antibiotic with anti-plague activity before hospital admission, whereas 55% had antibiotics with anti-plague activity detected in their serum at admission. Although there may have been overdiagnosis of plague by clinicians during the outbreak, the high frequency of community antibiotic may partly explain the relatively few culture-positive sputum samples during the outbreak. Community antibiotic use may have also altered the clinical presentation of plague patients. These issues make accurate detection of patients and the development of clinical case definitions and triage algorithms in urban pneumonic plague outbreaks difficult.
Fichier principal
Vignette du fichier
Factors Influencing 2017 Madagascar Pneumonic Plague Outbreak.pdf (95.56 Ko) Télécharger le fichier
Origin : Publication funded by an institution

Dates and versions

pasteur-03250581 , version 1 (04-06-2021)

Licence

Attribution

Identifiers

Cite

Alex P. Salam, Mihaja Raberahona, Prisca Andriantsalama, Liam Read, Faraniaina Andrianarintsiferantsoa, et al.. Factors Influencing Atypical Clinical Presentations during the 2017 Madagascar Pneumonic Plague Outbreak: A Prospective Cohort Study. American Journal of Tropical Medicine and Hygiene, 2020, 102 (6), pp.1309 - 1315. ⟨10.4269/ajtmh.19-0576⟩. ⟨pasteur-03250581⟩
39 View
78 Download

Altmetric

Share

Gmail Facebook X LinkedIn More