Bubonic plague: Description, Causes and Risk Factors:Alternative Name: Pestis bubonica, pestis fulminans, pestis major, glandular plague, polyadenitis maligna.ICD-10: A20.0A bacterial disease so lethal and so fast-spreading it still causes people to worry about epidemics. The affliction, if caught early, can be successfully treated. Bubonic plague was one of the most feared diseases of the ancient and medieval worlds.This plague has been responsible for at least 3 great pandemics and multiple epidemics in history. The first spread occurred from the Middle East to the Mediterranean basin during the fifth and sixth centuries AD, killing approximately 50% of the population in these areas. The second pandemic afflicted Europe between the 8th and 14th centuries, destroying nearly 40% of the population. The third pandemic started in approximately 1855 in China, and, although it has been mostly controlled, it is still ongoing.The organism responsible for bubonic plague is Pasteurella pestis (also called Yersinia pestis), which is spread by rodents and transmitted to man by fleas parasitic on rodents. This bacteria is found in rodents (the black rat during the great pestilence) and is transmitted from rats (and other rodents) to people by Xenopsylla cheopis (the oriental rat flea). Fleas (which jump from rodents to people) parasitically lodge themselves on the backs of their hosts (the rodents). The fleas' ready food source is the blood of the host. If the host is infected, the flea is likely to get infected. Initially, the bacteria blocks the flea's stomach and food tube. The flea becomes insatiably hungry. It goes on a feeding frenzy jumping to new hosts.When the starving flea bites its new human host, it typically does two things. It takes blood, of course, but it also squirts saliva, or partly digested blood, into the bite. If the flea is infected with plague bacteria, it will pass that infection on to its new host. This is how the disease spread.Risk factors may include:Living in a rural area and especially in areas where plague is common.
Having contact with sick animals, small rodents, or other possible hosts.
Exposure to flea bites.
People, such as biologists, trappers, and hunters, who handle potentially infected animals.
Exposure to naturally occurring plague in the community.
Participating in wilderness activities (such as camping, hiking, sleeping on the ground, hunting).
Employment as a veterinarian.
Symptoms:Symptoms of infection in humans begin within days after contamination with the plague bacterium. The bacteria enter the bloodstream and travel to various organs (e.g., kidney, liver, spleen, lungs) as well as to the brain.Initial symptoms include shivering, nausea with vomiting, headache, intolerance to light, and a whitish-appearing tongue.As the disease progresses, the victim bleeds internally and produces bloody urine and bloody stools. Dried blood puddling under the skin forms black boils which appear all over the body and the person ultimately die.Diagnosis:Plague is diagnosed by isolating the pathogen from the blood, sputum, pus and tissues. This diagnosis is then confirmed by immunological and molecular tests.Laboratory Test: A health care provider can diagnose bubonic plague by doing laboratory tests on blood or sputum, or on fluid from a lymph node.Blood tests for Pasteurella pestis bacteria.
Sputum tests for Pasteurella pestis bacteria.
Lymph tests for Pasteurella pestis bacteria.
In the US Public Health Service requires that all cases of suspected plague be reported immediately to local and state health departments and that the diagnosis be confirmed by CDC.Treatment:According to treatment experts, a patient diagnosed with suspected plague should be hospitalized and medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of lymph gland, blood, and sputum samples. Antibiotic treatment should begin as soon as possible after laboratory specimens are taken. Streptomycin is the antibiotic of choice. Gentamicin is used when streptomycin is not available. Tetracyclines and chloramphenicol are also effective. Persons who have been in close contact with a plague patient, particularly a patient with plague pneumonia, should be identified and evaluated.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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