Lessons learned about pneumonic plague diagnosis from 2 outbreaks, democratic republic of the Congo

Pneumonic plague is a highly transmissible infectious disease for which fatality rates can be high if untreated; it is considered extremely lethal. Without prompt diagnosis and treatment, disease management can be problematic. In the Democratic Republic of the Congo, 2 outbreaks of pneumonic plague occurred during 2005 and 2006. In 2005, because of limitations in laboratory capabilities, etiology was confi rmed only through retrospective serologic studies. This prompted modifi cations in diagnostic strategies, resulting in isolation of Yersinia pestis during the second outbreak. Results from these outbreaks demonstrate the utility of a rapid diagnostic test detecting F1 antigen for initial diagnosis and public health management, as well as the need for specialized sampling kits and trained personnel for quality specimen collection and appropriate specimen handling and preservation for plague confi rmation and Y. pestis isolation. Effi cient frontline management and a streamlined diagnostic strategy are essential for confi rming plague, especially in remote areas.