Plague in Vietnam. Clinical observations and treatment with kanamycin

The Role of Early-Phase Transmission in the Spread ofYersinia pestis

“…A majority of persons with untreated bubonic plague progress to sepsis, and septicemic and pneumonic cases typically die from overwhelming gram-negative bacteremia with its endotoxemic consequences (Butler 1972, 1983;Butler et al 1976; Dennis and Meier 1997). In severe, untreated illness, Y. pestis organisms can typically be seen on stained peripheral blood films (Cantey 1974, Butler et al 1976, Mann et al 1984), which is an ominous prognostic sign (Cantey 1974, Butler et al 1976, Dennis and Mead 2009). Although comparisons may be unreliable, the finding of a positive smear is generally considered equal to a bacteremia of 10 6 cfu/ml or greater (Douglas and Wheeler 1943, Torres and Bisno 1973).…”

“…Early attempts at quantitating degrees of bacteremia in fatal cases gave varying results with concentrations ranging from < 1 bacillus to > 10 6 bacilli per ml of blood (Indian Plague Research Commission [IPRC] 1906). During the 1960s and 1970s in wartime Vietnam, determinations were made of prevalence and density of bacteremia in several case series composed mostly of Vietnamese civilians with bubonic illness (Marshall et al 1967; Legters et al 1970; Butler 1972; Butler et al 1974, 1976; Cantey 1974). In the series reported by Cantey et al (1974), Y. pestis was isolated from 5 of 13 (38.5%) bubonic cases; of these, plague bacilli were microscopically observed on stained peripheral blood smears in 1 of 11 cases.…”

Use of Aminoglycosides in Treatment of Infections Due to Intracellular Bacteria

“…Streptomycin is considered highly effective for treatment of plague, whereas gentamicin and kanamycin have been proposed as alternative aminoglycosides (30,133). Chloramphenicol has been advocated for treating plague meningitis (18) because of its more favorable pharmacokinetic properties within the cerebrospinal fluid compared to that of aminoglycosides.…”

In vitro antimicrobial susceptibilities of strains of Yersinia pestis

“…One strain isolated from a Vietnamese rat was reportedly resistant to streptomycin (25 g/ml) (5, 10), but testing was not done by currently approved methods. Although streptomycin is usually regarded as the treatment of choice for plague, kanamycin has been used successfully for treatment in Vietnamese patients (3). Gentamicin has greater in vitro activity against Y. pestis and is now more widely used in other infections than the earlier aminoglycosides.…”