[gwynhefar (OP)]

Saw a TV show episode once with an interesting plot -- weaponized bioengineered pneumonic plague.  This nasty bug was engineered to be antibiotic-resistant, and of course one of the main characters was exposed.  They knew immediately what it was, and he got into decontam right away, but still caught the disease.  In the show, he survived, barely, and I started wondering how realistic that was. 

I know pneumonic plague has basically a 100% fatality rate without antibiotics in the real world, but that's considering that people either don't get treatment because it's not diagnosed fast enough, or because there isn't sufficient medical support in their area.  Also, most cases like this occur in rural, poverty-stricken environments where the victim is generally not in the best health to begin with.

So, hypothetically, if a very healthy man in his 30s contracts pneumonic plague, and is immediately treated with everything modern medicine can provide *except* antibiotics, does he have a chance to survive?  What do y'all think?

[chris]

Pneumonic plague is the respiratory manifestation of infection with Yersinia pestis, the same bacterium that also causes bubonic plague (and hence probably the "Black Death" historically) when inoculated through the skin by flea bites. The bacterium has a relative called Yersinia enterocolitica that causes a form of food poisoning.

Untreated, Y. pestis pneumonia is almost universally fatal. The cause of death is usually acute respiratory failure complicated by septicaemia. The burden of toxic and inflammatory materials entering the bloodstream, combined with hypoxia from the lung involvement, is an overwhelming insult that causes unrecoverable biochemical collapse.

Respiratory support can help people through the lung problem, but the presence of hostile microorganisms collectively poisoning the well from within means that this would still, at best, just defer death rather than prevent it. Recovery depends upon neutralisation of the infection, and that means antibiotics.

Treated, the prognosis is a bit better. The best odds are achieved with the earliest treatment intervention. Delayed or deferred treatment carries a progressively grimmer prognosis.

[Bored chemist]

It's possible that someone might survive a  non-pneumonic infection with Y pestis.
Having done so they would have considerable immunity.
They might then get a lung infection which would be much less damaging that it normally would be.

It also depends on what you consider to be an antibiotic.
Some of the sulphonamides will kill the bacteria- but things like penicillin are better.
If all you had was sulphonamides they would be worth trying

Otherwise, it's pretty much a death sentence.

[gwynhefar (OP)]

That's what I figured.  The TV show didn't go into that much detail simply saying that the bug was "bioengineered" to not respond to "antibiotics".  The fact that the infected guy survived and recovered always struck me as inaccurate, given what I knew of pneumonic plague.  I guess I was wondering if there were any immune boosters or some other types of medicine that weren't antibiotics but could help his body fight it off without them. 

[Bored chemist]

The TV show didn't go into that much detail

That's because they make stuff up.
In that case  science no longer applies.