Plague


PLAGUE

Description:

An acute infectious disease caused by the bacterium Yersinia pestis and marked clinically by high fever, toxemia, prostration, a petechial eruption, lymph node enlargement, and pneumonia, or hemorrhage from the mucous membranes; primarily a disease of rodents, transmitted to humans by fleas that have bitten infected animals. In humans the disease takes one of four clinical forms: bubonic plague, septicemic plague, pneumonic plague, or ambulant plague Syn: pest, pestilence, pestis.

Terminology related with Plague:

Ambulant plague, black plague, bubonic plague, glandular plague, hemorrhagic plague, larval plague, Pahvant Valley plague, pneumonic plague, pulmonic plague, septicemic plague, sylvatic plague

Plague is a zoonotic disease circulating mainly among small animals and their fleas. The bacteria Yersinia pestis can also infect humans. It is transmitted between animals and humans by the bite of infected fleas, direct contact, inhalation and rarely, ingestion of infective materials.

Infected persons usually start with “flu-like” symptoms after an incubation period of 3-7 days. Patients typically experience the sudden onset of fever, chills, head and body-aches and weakness, vomiting and nausea.

Types:

    Bubonic: Bubonic form is the most common form of plague resulting from the bite of an infective flea. Plague bacillus enters the skin from the site of the bite and travels through the lymphatic system to the nearest lymph node. The lymph node then becomes inflamed because the plague bacteria, Yersinia pestis or Y. pestis, will replicate here in high numbers. The swollen lymph node is called a "bubo" which is very painful and can become suppurated as an open sore in advanced stage of infection;

  • Septicaemic: Septicaemic form of plague occurs when infection spreads directly through the bloodstream without evidence of a "bubo". More commonly advanced stages of bubonic plague will result in the presence of Y. pestis in the blood. Septicaemic plague may result from flea bites and from direct contact with infective materials through cracks in the skin.

  • Pneumonic: Pneumonic form of plague is the most virulent and least common form of plague. Typically, pneumonic form is due to a secondary spread from advanced infection of an initial bubonic form. Primary pneumonic plague results from inhalation of aerosolized infective droplets and can be transmitted from human to human without involvement of fleas or animals. Untreated pneumonic plague has a very high case-fatality ratio.

Death occurs quickly with pneumonic plague - within three or four days - and even faster with the septicaemic type: 24 hours. In all three, internal bleeding causes large bruises to appear on the skin.

Plague cases are on the rise and are afflicting countries more frequently than before. A who report says there were around 1,900 cases worldwide in 2002, which increased to 2,100 cases in 2003. Earlier, most plague cases were found in Asia but now 90 per cent of them are reported from Africa. Although the disease is spreading, very little is known about the dynamics of plague in its natural reservoirs and about changing risks for humans.

In general, to prevent contracting plague, people should avoid contact with wild animals. Controlling rat and flea populations where plague is found is also important.

Symptoms:

Common symptoms include fever, chills, headache, sore throat, body aches, nausea, vomiting, diarrhea, cough, shortness of breath, confusion, heart irregularities, and low blood pressure.

Causes and Risk factors:

Plague is an infectious disease caused by bacteria called Yersinia pestis. These bacteria are found mainly in rodents, particularly rats, and in the fleas that feed on them. Other animals and humans usually contract the bacteria from rodent or flea bites.

Y. pestis is found in animals throughout the world, most commonly in rats but occasionally in other wild animals, such as prairie dogs. Most cases of human plague are caused by bites of infected animals or the infected fleas that feed on them. In almost all cases, only the pneumonic form of plague can be passed from person to person.

When a person is bitten by an infected flea, the plague bacteria move through the bloodstream to the lymph nodes. The lymph nodes swell, causing the painful lumps ("buboes") that are characteristic of bubonic plague, soon the bacteria can multiply in the bloodstream and produce plague septicemia (septicemia plague), severe blood infection.

Certain forms of the plague can even be spread from human to human. When someone with the plague coughs, microscopic droplets carrying the infection move through the air. Anyone who breathes in these particles can catch the disease. An epidemic may be started this way.

Risk factors:

  • 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.

Diagnosis:

Several diseases share similar symptoms of plague. The doctor will consider these conditions and rule them out before making a plague diagnosis.In order to make a plague diagnosis, the doctor will ask a number of questions about a person's medical history e.g. History of possible exposure to infected rodents, rabbits, or fleas, recent travel history.

Laboratory Test: A health care provider can diagnose plague by doing laboratory tests on blood or sputum, or on fluid from a lymph node.

    Blood tests for Yersinia pestis bacteria.

  • Sputum tests for Yersinia pestis bacteria.

  • Lymph tests for Yersinia pestis bacteria.

Treatment:

If diagnosed in time, plague is treatable with antibiotics. Treatment of suspected plague cases should start as soon as possible after the laboratory specimens are taken. The drug of choice is streptomycin, but several other antibiotics are also effective. Other drugs may include Aminoglycosides, Chloramphenicol, Tetracyclines, Sulfonamides, and Fluoroquinolones.

Supportive Therapy: The clinician must prepare for intense supportive management of plague complications, utilizing the latest developments for dealing with Gram-negative sepsis. Aggressive monitoring and management of possible septic shock, multiple organ failure, adult respiratory distresssyndrome (ARDS) and disseminated intravascular coagulopathy should be instituted.

Medicine and medications:

Gentamicin, Chloramphenicol, Streptomycin sulfate, Doxycycline, Vibramycin, Tetracycline, Ciprofloxacin, and Bactrim.

Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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