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Medscape Personal Professor: Plague

  • Authors: Author: Vincent E. Friedewald, MD
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Target Audience and Goal Statement

This activity is intended for primary care physicians, internists, family physicians, emergency medicine physicians, advanced practice nurses, and physician assistants.

Upon completion of this activity, participants will be able to:

  1. Recognize the key clinical features of plague.
  2. Differentiate plague from bacterial pneumonia.
  3. Identify the characteristic that could help differentiate pneumonic plague.
  4. Discuss the general management of patients who have plague or who are at moderate or high risk for plague.


  • Vincent E. Friedewald, MD

    The William and Helen Carey Chair in Modern Communications, University of Notre Dame, Notre Dame, Indiana


    Disclosure: Dr. Friedewald has no significant financial interests to disclose. In this activity he discusses an unlabeled use of Gentamicin.


  • Peggy Keen, PhD, RNC

    Editor and Program Director, Medscape Family Medicine


    Disclosure: Peggy Keen has no significant financial interests or relationships to disclose.

Accreditation Statements

    For Physicians

  • The A. Webb Roberts Center for Continuing Education of Baylor Health Care System, Dallas, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    A. Webb Roberts Center of Baylor Health Care System, Dallas, designates this educational activity for a maximum of 1 category 1 credit(s) toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

    The American Medical Association has determined that non-US licensed physicians who participate in this CME activity are eligible for AMA PRA category 1 credit.

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    For Nurses

  • This educational activity for 1.2 contact hours is provided by Postgraduate Institute for Medicine. Postgraduate Institute for Medicine is approved as a provider of continuing education in nursing by the Colorado Nurses Association, which is accredited as an approver of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation. California Board of Registered Nursing

    The Postgraduate Institute for Medicine is approved by the California Board of Registered Nursing, Provider Number 13485 for 1.2 contact hours.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
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Medscape Personal Professor: Plague


Discussion: Microbiology

The correct answers are 1, 2, 3, and 5. Sputum, blood, and infected lymph node aspirate should be examined for the presence of Y pestis. The Y pestis organism may appear as a Gram-negative bacillus in any of these sources.

Y pestis may be seen in smears of the sputum, peripheral blood, or lymph node aspirate. The organism is a Gram-negative bacillus or coccobacillus[4] demonstrating bipolar staining with the Wright, Giemsa, or Wayson stains, and may exhibit a characteristic "safety pin" appearance. Positive cultures from these sources may appear within 24-48 hours, but may take as long as 6 days.

Figure 6. "Safety pin" appearance of Y pestis on Wayson stain of peripheral blood smear. Figure from Centers for Disease Control and Prevention.
Figure 7. Wright, Giemsa stains of peripheral blood smear showing characteristic bipolar staining. Figure from Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases, Fort Collins, Colorado.