Review of Current Literature

Since the number of plague cases notified to the World Health Organization has increased and because, having been quiescent for many years, plague has reappeared in epidemic form in several countries including India, Malawi and Mozambique during 1994 while the number of enzootic foci is gradually expanding in some countries, plague is now considered a re-emerging disease. For instance, in the United States the number of states reporting human plague increased from 3 in the 1950s to 13 in the 1990s. Isolates of Yersiniapestis, the causative agent of plague, typically show susceptibility to antibiotics used against gram-negative bacteria. A report by Gallimand et al. 1997' concerns a 16-year-old boy in Madagascar who, during 1995, developed a febrile illness which initially was diagnosed as malaria and treated as such with quinine. Three days later, a right inguinal bubo, hyperpyrexia (4loC), delirium and prostration suggested that the patient suffered &om plague which was subsequently confirmed by isolation of Yevsinia pestis (strain 17/95) from bubo aspirate. He recovered on treatment with twice daily intramuscular streptomycin (2 g daily for 4 days) and oral trimethoprim-sulfamethoxazole (TMP/SMZ) (2 g daily for 10 days). Disk agar diffusion tests showed that the Ypestis isolate was resistant to ampicillin, chloramphenicol, kanamycin, streptomycin, spectinomycin, tetracycline, minocycline and sulfonamides. It was susceptible to trimethoprim, cephalosporins, other aminoglycosides, and quinolones. It is thought that the patient's recovery was most likely due to the action of trimethoprim despite an absence of synergistic activity by sulfamethoxazole. The observed multiresistance was found to be mediated by a single plasmid which, in vitro, was readily transferred between Ypestis 17/95 and E. coli and from 17/95 to other isolates of YpestixThis finding is of great concern.