Future bioterrorism acts are an unfortunate possibility for which healthcare providers and medical systems must prepare. Plague, caused by Yersinia pestis, is a potential bioterrorism agent which healthcare providers in the developed world have only a low familiarity. This article provides a teaching strategy using medical simulation to assist healthcare professionals and institutions in preparing for bioterrorism events.
Yersinia pestis is the etiologic agent for plague, one of the category A potential biologic weapons as categorized by the Center for Disease Control and Prevention. Category A infections (1) can be easily transmitted from person to person (2) result in high mortality rates (3) may cause public panic and disruption and (4) require special action for public health preparedness. The large outbreaks of pneumonic plague in its natural form that have occurred in the past provide the only available clinical experience with human pneumonic plague. Intentional dissemination of plague could occur by aerosolized Yersinia pestis. This mechanism has been shown to produce disease in nonhuman primates.
The first signs of illness expected would be fever with cough with the production of bloody, watery, or purulent sputum, and dyspnea. Prominent gastrointestinal symptoms including nausea, vomiting, abdominal pain, and diarrhea may also be present . Chest X-ray findings are variable but bilateral infiltrates or consolidation are usually seen with a propensity for the lower lobes; mediastinal and hilar adenopathy may also be seen. Patients with pneumonic plague deteriorate very rapidly. Early diagnosis is extremely important for patient survival. Therefore frontline healthcare providers should have training in the diagnosis and management of bioterrorism agents such as pneumonic plague. Suboptimal physician training in bioterrorism preparedness has been described.