Disease: Plague (Black Death)

    Plague (Black Death) facts

    • Plague is an infectious disease caused by the bacteria known as Yersinia pestis.
    • Plague has a high fatality rate and has been described for centuries.
    • In the Middle Ages, plague was known as the "Black Death" and caused the death of 60% of the population of Europe.
    • Transmission occurs via fleas that feed on infected rodents.
    • There are three forms of plague in humans: bubonic plague, septicemic plague, and pneumonic plague.
    • The signs and symptoms of plague generally develop between two and seven days after a person acquires the infection. Symptoms and signs depend on one of the three forms of plague and include:
      • Bubonic plague symptoms and signs include painful and enlarged lymph nodes, chills, headache, fever, and weakness.
      • Septicemic plague symptoms and signs (black death or black plague) include fever, weakness, abdominal pain, chills, and shock. Tissue bleeding and death may cause the dying tissues to appear black.
      • Pneumonic plague symptoms and signs include characteristic pneumonia symptoms like chest pain, shortness of breath, cough, fever, chills, nausea, vomiting, and diarrhea.
    • Antibiotics are the treatment of choice for plague and are most effective when given early in the course of disease.
    • There is no commercially available vaccine against plague.
    • Plague may be found in low levels in animals in the southwestern U.S.
    • Diagnosis of plague depends upon identifying the causative bacteria in fluid or tissue samples.

    What is plague? What is the history of plague?

    Plague is a bacterial disease that is infamous for causing millions of deaths in the Middle Ages in Europe. Many historical references describe the illness, which has been referred to as the Black Death. The first reported plague pandemic began in 541 A.D. and lasted for over 200 years, killing an estimated 100 million people or more throughout the Mediterranean basin. The so-called Black Death, or pandemic of the Middle Ages, began in China and made its way to Europe, causing the death of 60% of the entire population. The third, or modern, pandemic started in China in the 19th century and spread to port cities all over the world. Most recently, the World Health Organization reported an outbreak of plague in Madagascar in Nov. 2014. The outbreak affected over 100 patients and caused at least 40 deaths.

    Rodents and many other kinds of animals can be infected with plague-causing bacteria. People contract the bacteria through bites of fleas that have fed on infected rodents. Humans can also develop the infection from handling fluids or tissues from infected animals. People with plague pneumonia can also transmit the infection to other humans via coughing infectious droplets into the air.

    What causes plague?

    The bacteria that cause plague are known as Yersinia pestis. In the natural state, the bacteria infect wild rodents. Plague can still be found in many areas of the world, but 95% of cases today occur in Madagascar and sub-Saharan Africa. The World Health Organization states that between 1,000-2,000 cases are reported each year worldwide, but there are estimated to be more cases that go unreported. The bacteria are found in the U.S. in semi-arid areas of the southwest. Fleas that feed off of infected animals transmit the bacteria to other animals. Rats, ground squirrels, mice, prairie dogs, chipmunks, voles, and rabbits are examples of animals that may carry the plague bacteria. The bacteria are believed to persist at a low level in natural populations of these animals. When a large number of infected wild rodents die, fleas that have bitten these animals may bite humans and domestic animals. Cats that are bitten usually become ill, and they may cough infectious droplets into the surrounding air. While infected dogs may not appear ill, they may still carry infected fleas into the home.

    The last urban outbreak of flea-transmitted plague in the U.S. occurred in the 1920s. Plague in the U.S. is rare today but occasionally occurs in the southwestern portion of the country where wild rodents may be infected. Between 1900-2012, 999 confirmed or probable cases of plague occurred in the U.S.

    What are risk factors for plague?

    Risk factors for plague include being bitten by fleas as well as exposure to rodents. Scratches or bites from infected domestic cats are also a risk factor. Contact with individuals with pneumonic plague (pneumonia caused by the plague bacteria, see below) is also a risk factor for acquiring the infection.

    What are plague symptoms and signs?

    Symptoms and signs of plague usually develop between two and seven days after acquiring the infection, although they may appear after only one day in cases of exposure to pneumonic plague. The signs and symptoms may take three forms:

    Bubonic plague: In this form of the infection, bacteria infiltrate the lymph nodes, causing enlarged, painful, tender lymph nodes called buboes. Accompanying symptoms are fever, chills, headaches, and weakness. If not treated, the infection can spread to other areas of the body.

    Septicemic plague: This form of plague is a result of plague bacteria entering the bloodstream. It can occur on its own or may develop from bubonic plague. Symptoms include fever, chills, weakness, abdominal pain, and shock. There can be bleeding and tissue death, especially of the fingers and toes. These dying tissues may appear black, hence the name "black death."

    Pneumonic plague: In this form of the illness, symptoms of other types of plague can be present, but the characteristic clinical picture of pneumonia is present. The plague bacteria spread to the lungs or infect the lungs directly when infected droplets in the air are inhaled. This is the only form of plague that can be transmitted from person to person. Shortness of breath, chest pain, and cough with watery or bloody mucus production are symptoms of pneumonic plague.

    How do physicians diagnose plague?

    The diagnosis of plague depends upon identifying Yersinia pestis organisms in a sample of blood or tissue (such as an aspirate from an enlarged lymph node) from the infected patient. Diagnostic tests rely on culturing the organism, demonstrating the surface proteins of the bacteria, or identifying genetic material of the bacteria. Tests to identify the body's antibody response to the infection are also available.

    What is the treatment for plague?

    Antibiotics are effective in treating plague. Examples of antibiotics that can be used include ciprofloxacin (Cipro, Cipro XR, Proquin XR), streptomycin, gentamicin (Garamycin), and doxycycline (Vibramycin, Oracea, Adoxa, Atridox). People with plague are very ill and may require additional treatment, including oxygen, respiratory support, and medications to maintain adequate blood pressure. Patients with pneumonic plague must be isolated while in treatment to avoid spreading the infection.

    Learn more about: Cipro | Cipro XR | Proquin XR | streptomycin | Vibramycin | Oracea | Adoxa | Atridox

    What is the prognosis of plague?

    Plague is a very serious illness that is often fatal. About 50% of people with bubonic plague die if their illness is not treated. Pneumonic plague is typically always fatal if untreated. With treatment, about half of people with pneumonic plague will survive. The earlier that antibiotic treatment is given, the better the chance for recovery.

    What causes plague?

    The bacteria that cause plague are known as Yersinia pestis. In the natural state, the bacteria infect wild rodents. Plague can still be found in many areas of the world, but 95% of cases today occur in Madagascar and sub-Saharan Africa. The World Health Organization states that between 1,000-2,000 cases are reported each year worldwide, but there are estimated to be more cases that go unreported. The bacteria are found in the U.S. in semi-arid areas of the southwest. Fleas that feed off of infected animals transmit the bacteria to other animals. Rats, ground squirrels, mice, prairie dogs, chipmunks, voles, and rabbits are examples of animals that may carry the plague bacteria. The bacteria are believed to persist at a low level in natural populations of these animals. When a large number of infected wild rodents die, fleas that have bitten these animals may bite humans and domestic animals. Cats that are bitten usually become ill, and they may cough infectious droplets into the surrounding air. While infected dogs may not appear ill, they may still carry infected fleas into the home.

    The last urban outbreak of flea-transmitted plague in the U.S. occurred in the 1920s. Plague in the U.S. is rare today but occasionally occurs in the southwestern portion of the country where wild rodents may be infected. Between 1900-2012, 999 confirmed or probable cases of plague occurred in the U.S.

    What are risk factors for plague?

    Risk factors for plague include being bitten by fleas as well as exposure to rodents. Scratches or bites from infected domestic cats are also a risk factor. Contact with individuals with pneumonic plague (pneumonia caused by the plague bacteria, see below) is also a risk factor for acquiring the infection.

    What are plague symptoms and signs?

    Symptoms and signs of plague usually develop between two and seven days after acquiring the infection, although they may appear after only one day in cases of exposure to pneumonic plague. The signs and symptoms may take three forms:

    Bubonic plague: In this form of the infection, bacteria infiltrate the lymph nodes, causing enlarged, painful, tender lymph nodes called buboes. Accompanying symptoms are fever, chills, headaches, and weakness. If not treated, the infection can spread to other areas of the body.

    Septicemic plague: This form of plague is a result of plague bacteria entering the bloodstream. It can occur on its own or may develop from bubonic plague. Symptoms include fever, chills, weakness, abdominal pain, and shock. There can be bleeding and tissue death, especially of the fingers and toes. These dying tissues may appear black, hence the name "black death."

    Pneumonic plague: In this form of the illness, symptoms of other types of plague can be present, but the characteristic clinical picture of pneumonia is present. The plague bacteria spread to the lungs or infect the lungs directly when infected droplets in the air are inhaled. This is the only form of plague that can be transmitted from person to person. Shortness of breath, chest pain, and cough with watery or bloody mucus production are symptoms of pneumonic plague.

    How do physicians diagnose plague?

    The diagnosis of plague depends upon identifying Yersinia pestis organisms in a sample of blood or tissue (such as an aspirate from an enlarged lymph node) from the infected patient. Diagnostic tests rely on culturing the organism, demonstrating the surface proteins of the bacteria, or identifying genetic material of the bacteria. Tests to identify the body's antibody response to the infection are also available.

    What is the treatment for plague?

    Antibiotics are effective in treating plague. Examples of antibiotics that can be used include ciprofloxacin (Cipro, Cipro XR, Proquin XR), streptomycin, gentamicin (Garamycin), and doxycycline (Vibramycin, Oracea, Adoxa, Atridox). People with plague are very ill and may require additional treatment, including oxygen, respiratory support, and medications to maintain adequate blood pressure. Patients with pneumonic plague must be isolated while in treatment to avoid spreading the infection.

    Learn more about: Cipro | Cipro XR | Proquin XR | streptomycin | Vibramycin | Oracea | Adoxa | Atridox

    What is the prognosis of plague?

    Plague is a very serious illness that is often fatal. About 50% of people with bubonic plague die if their illness is not treated. Pneumonic plague is typically always fatal if untreated. With treatment, about half of people with pneumonic plague will survive. The earlier that antibiotic treatment is given, the better the chance for recovery.

    Source: http://www.rxlist.com

    The diagnosis of plague depends upon identifying Yersinia pestis organisms in a sample of blood or tissue (such as an aspirate from an enlarged lymph node) from the infected patient. Diagnostic tests rely on culturing the organism, demonstrating the surface proteins of the bacteria, or identifying genetic material of the bacteria. Tests to identify the body's antibody response to the infection are also available.

    Source: http://www.rxlist.com

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