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Bubonic Plague

Bubonic plague is a rare, contagious disease caused by the bacterium Yersinia pestis, characterized by painful buboes in the axilla, groin or neck, high fever, petechial hemorrhage and delirium.


Presentation

Symptoms of bubonic plague usually appear suddenly within 2 to 5 days after the human is bitten by infected flea. In a plague of this kind, the lymphatic system is most affected causing development of bubo which is characterized by painful swelling of the lymph gland. The bubo generally develops in the groin region, but can also occur in the armpits and or the neck. The site of development is usually the site of insect bite. Individuals also suffer from pain before the onset of swelling. In addition, individuals with bubonic plague may also suffer from malaise, fever with chills, headache, seizures and muscle aches.

Fever
  • An 8-year-old Navajo boy presented to the emergency department with fever and altered mental status.[ncbi.nlm.nih.gov]
  • Bubonic plague is a rare, contagious disease caused by the bacterium Yersinia pestis, characterized by painful buboes in the axilla, groin or neck, high fever, petechial hemorrhage and delirium.[symptoma.com]
  • The CDC notes that healthcare providers should consider plague in patients who have traveled to plague-endemic areas and exhibit fever, headache, chills, weakness, and one or more swollen or tender and painful lymph nodes, referred to as buboes.[ncbi.nlm.nih.gov]
  • Pneumonic plague: Patients develop fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous.[cdc.gov]
  • ‘In addition to treating tuberculosis, streptomycin was effective against typhoid fever, cholera, bubonic plague and other diseases.’[en.oxforddictionaries.com]
Chills
  • The CDC notes that healthcare providers should consider plague in patients who have traveled to plague-endemic areas and exhibit fever, headache, chills, weakness, and one or more swollen or tender and painful lymph nodes, referred to as buboes.[ncbi.nlm.nih.gov]
  • Bubonic plague: Patients develop sudden onset of fever, headache, chills, and weakness and one or more swollen, tender and painful lymph nodes (called buboes). This form usually results from the bite of an infected flea.[cdc.gov]
  • In addition, affected individuals also suffer from fever, along with chills, malaise, headache and muscle ache. Diagnosis Diagnosis of bubonic plague is made through a preliminary physical examination of the bubo.[symptoma.com]
  • […] bubonic plague the most common form of the plague in humans pulmonic plague a rapidly progressive and frequently fatal form of the plague that can spread through the air from person to person; characterized by lung involvement with chill, bloody expectoration[vocabulary.com]
  • Other symptoms of bubonic plague include headache, fever, chills, and weakness. Bubonic plague can lead to gangrene (tissue death) of the fingers, toes, and nose. Also called Black Death and Black Plague.[medicinenet.com]
High Fever
  • fever pneumonic plague a rapidly progressive and frequently fatal form of the plague that can spread through the air from person to person; characterized by lung involvement with chill, bloody expectoration and high fever Black Plague the epidemic form[vocabulary.com]
  • Early symptoms of plague include high fever, chills, nausea, weakness and swollen lymph nodes in the neck, armpit or groin. Reporting by Victoria Cavaliere; Editing by Kavita Chandran[reuters.com]
  • Common symptoms include high fever, muscle aches, and tumors called buboes. Another symptom can also include black spots, vomiting of blood, skin and flesh deterioration. Once infected, victims often died two to seven days after being infected.[disclose.tv]
  • The body's natural immune defenses kick in, causing a high fever in an attempt to kill the bacteria. Chills, muscle pain and weakness are also common.[science.howstuffworks.com]
Camping
  • “Many San Franciscans lived in crowded temporary shelters and cottages in refugee camps. Accumulated garbage and debris created a congenial environment for rats, some of which carried bubonic plague.”[findingdulcinea.com]
  • But, if you live out West and plan to go hiking or camping any time soon, don't go touching any dead squirrels. Actually, don't ever touch dead squirrels. Don't touch dead anything. Just don't.[thewire.com]
  • The parents of 7-year-old Sierra Jane Downing thought she had the flu when she felt sick days after camping in southwest Colorado.[cbsnews.com]
  • In Leviticus, chapter 13, it is stated that anyone with leprosy remains unclean as long as they have the disease and that they must live outside the camp away from others [ 1, Lev. 13.46].[doi.org]
Hunting
  • Marmots are known to be susceptible to Bubonic plague and hunting them in Siberia is banned as a result (Reuters) At least 4,000 local residents will be vaccinated as a precaution.[independent.co.uk]
  • While Rex hunts down and devours notifies the web team, please consider: Using the search box at the top of the page to continue your journey.[ucalgary.ca]
  • When hunting, hiking, or playing with rodents this spooky season, remember that that the plague is still alive and well. [ Image via Flickr ][gawker.com]
  • Seven of the eight cases occurred in adult males who had hunted rabbits during winter months in plague-endemic areas. These patients had upper extremity buboes, and the case-fatality ration for the group was 50%.[ncbi.nlm.nih.gov]
  • She is believed to have contracted it from a flea bite she obtained on an Oct. 16 hunting trip but was just hospitalized on the 24th.[cosmopolitan.com]
Cough
  • Whooping cough Whooping cough, or pertussis, is yet another disease that's made a comeback in recent years, and the anti-vaccination movement isn't the only reason why.[pri.org]
  • Symptoms in patients with pneumonic plague include cough, chest pain, bronchopneumonia, labored breathing, and hemoptysis (blood in the fluid produced by coughing).[web.archive.org]
  • If the bacteria reach the lungs, the patient develops pneumonia (pneumonic plague), which is then transmissible from person to person through infected droplets spread by coughing.[who.int]
  • It is not transmitted from human to human unless the patient also has a lung infection and is coughing.[seattletimes.com]
  • […] description There are two clinical forms of the disease: bubonic plague, characterized by painfully inflamed lymph nodes called "buboes'', an elevated temperature and an altered clinical state; and pulmonary plague which manifests itself as thoracic pain, a cough[orpha.net]
Aspiration
  • The sensitivity of the dipstick assay was 98% on bubo aspirates specimens. Compared to the ELISA test, the agreement rate was 97.5% and the correlation coefficient tau 0.90 (p 10(-3)).[ncbi.nlm.nih.gov]
  • Cultures from an aspirate of the node, her sputum, and blood all showed growth of Yersinia pestis. She was treated successfully with aminoglycosides and tetracycline.[ncbi.nlm.nih.gov]
  • Abstract The diagnostic value of a PCR assay that amplifies a 501-bp fragment of the Yersinia pestis caf1 gene has been determined in a reference laboratory with 218 bubo aspirates collected from patients with clinically suspected plague managed in a[ncbi.nlm.nih.gov]
  • Lymph node aspirates from 149 patients from Madagascar with the clinical diagnosis of bubonic plague were investigated for the detection of Y. pestis DNA.[ncbi.nlm.nih.gov]
  • Egypt's ruler, Ismail (1863-79), had been educated in France and aspired to have his capital rival Paris. To coincide with the ceremonies for the opening of the Suez Canal, Ismail proposed a design for "modern" Cairo.[countrystudies.us]
Hemoptysis
  • Symptoms in patients with pneumonic plague include cough, chest pain, bronchopneumonia, labored breathing, and hemoptysis (blood in the fluid produced by coughing).[web.archive.org]
Abdominal Pain
  • Septicemic plague: Patients develop fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially on fingers, toes, and the nose.[cdc.gov]
  • They include an overall feeling of sickness, sudden fever, abdominal pain, swollen lymph nodes, nausea and vomiting. The plague can be successfully treated with antibiotics, but only with a prompt diagnosis and treatment.[cbs4indy.com]
  • It is followed by body aches, extreme exhaustion, and abdominal pain. Painful lymph node swelling called buboes appear in the groin and armpits, which ooze pus and blood.[militaryhistoryonline.com]
  • In addition to respiratory disease, patients with pneumonic plague often show gastrointestinal signs such as nausea, abdominal pain, vomiting, and diarrhea. Patients with primary pneumonic plague rarely develop buboes.[web.archive.org]
Purpura
  • Butler [11] states the term refers to the haemorrhagic purpura and ischaemic gangrene of the limbs that sometimes ensued from the septicaemia.[jmvh.org]
  • Symptoms are high fevers and purple skin patches (purpura due to disseminated intravascular coagulation).[en.wikipedia.org]
Headache
  • The CDC notes that healthcare providers should consider plague in patients who have traveled to plague-endemic areas and exhibit fever, headache, chills, weakness, and one or more swollen or tender and painful lymph nodes, referred to as buboes.[ncbi.nlm.nih.gov]
  • Pneumonic plague: Patients develop fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous.[cdc.gov]
  • In addition, affected individuals also suffer from fever, along with chills, malaise, headache and muscle ache. Diagnosis Diagnosis of bubonic plague is made through a preliminary physical examination of the bubo.[symptoma.com]
  • Other symptoms of bubonic plague include headache, fever, chills, and weakness. Bubonic plague can lead to gangrene (tissue death) of the fingers, toes, and nose. Also called Black Death and Black Plague.[medicinenet.com]
  • Patients will experience headaches, fever, swollen lymph nodes, and can even lose appendages, such as fingers and toes. Read the full story at NPR News.[cnbc.com]
Confusion
  • They include “headache and a general feeling of weakness, followed by aches and chills in the upper leg and groin, a white coating on the tongue, rapid pulse, slurred speech confusion, fatigue, apathy, and a staggering gait.[christianitytoday.com]
  • Among all the confusing and contradictory recommendations, a few people actually did hit upon some effective solutions: isolation, and heat to kill the bacteria.[onlinenursingdegrees.org]
  • To the second question, I say that it arises from the sea, as the evangelist says: "There shall be signs in the sun and in the moon and in the stars; and upon the earth distress of nations, by reason of the confusion of the roaring of the sea and of the[bbc.co.uk]
  • AIDS and its threat to mankind, especially in africa, naturally provokes a quest for a silver lining, not of course to be confused with a moral justification for such misery.[time.com]
  • 2000 VOL. 156 NO. 3 A Distant Mirror Europe's Black Death is a history lesson in human tragedy — and economic renewal By PETER JAY AIDS and its threat to mankind, especially in africa, naturally provokes a quest for a silver lining, not of course to be confused[web.archive.org]
Altered Mental Status
  • An 8-year-old Navajo boy presented to the emergency department with fever and altered mental status.[ncbi.nlm.nih.gov]
Altered Mental Status
  • An 8-year-old Navajo boy presented to the emergency department with fever and altered mental status.[ncbi.nlm.nih.gov]

Workup

To diagnose bubonic plague, samples will be taken from the body to analyze for the presence of bacteria. Following this, the development of buboes will be carefully examined. In addition, fluid from the buboes will be drawn to test for the presence of bacteria. Blood culture test are also required which would reveal bacteria.

An effective tool for rapid diagnosis of bubonic plague has been introduced. This test is known as direct immunofluorescence testing of body fluids. Such a kind of method is helpful in analyzing even small amounts of Yersinia pestis in the sample within 15 minutes [7].

Treatment

For early remission of the disease, antibiotics are administered within 24 hours of appearance of the preliminary signs and symptoms. Antibiotics form the preliminary basis of treatment regime, which includes gentamicin, ciprofloxacin, streptomycin and doxycycline. In cases where the symptoms have taken a severe form, hospitalization would be required [8] [9].

Prognosis

If treatment is initiated with antibiotics, then the prognosis is usually favorable. Patients survive the disease condition and gradually recover completely. However, when the treatment is delayed, then several complications can set in, which can finally lead to death. According to the National Institute of Health (NIH), about 50% individuals with bubonic plague die, due to lack of initiation of treatment in the right time. It has also been reported that the death rate can be significantly reduced by 50% when treatment is given [6].

Etiology

Bubonic plague is caused by bacteria known as Yersinia pestis. The bacteria are spread by infected fleas that commonly reside on rodents such as mice and rats. In rare cases, the disease is spread when the individual comes in contact with an infected material used by the infected person. Individuals can also contract the disease condition, if there is a break in the skin and they come in contact with an infected animal’s blood. Scratches from infected domestic animals, such as cats or rats, can also predispose an individual to develop bubonic plague [2].

Epidemiology

The past era has witnessed a high incidence of bubonic plague. It was responsible for significant cases of mortality in the 14th century. In the period of 1994 to 1999, about 49 cases of plague were reported from different states namely Arizona, California, Utah and New Mexico. It was also estimated that 50 to 90% cases of untreated bubonic plague were a cause of mortality. In spite of strict preventive measures, cases of plague still have noted in Madagascar. About 138 new cases of bubonic plague have been reported in this island [3] [4].

Sex distribution
Age distribution

Pathophysiology

There are basically 2 stages involved with the pathophysiology of plague development in humans. These include cycle within fleas, and cycle within humans. Individuals usually develop bubonic plague when they are bitten by infected fleas who have fed on animals infected with the bacteria. Once the human is bitten, the bacteria gains entry through the skin and attacks the lymphatic system. Such a phenomenon promotes swelling of the lymph glands, giving rise to development of buboes in the axilla, groin and neck region [5].

Prevention

Controlling the rodent population can help in considerable prevention of plague. Keeping the pets safe from fleas also would help in keeping the disease at bay. It is also necessary to use insect repellants to keep insects and fleas out from home. Individuals, who spend significant amount of time outdoors, are advised to use natural insect repellants such as citronella which would keep fleas and insects away.

Vaccinations against plague are available; however they are meant for the laboratory staff that is at high risk of developing the disease. According to the guidelines issued by WHO, the plague vaccine is not appropriate in case of outbreaks [10].

Summary

Bubonic plague is a bacterial disease caused by infected fleas that reside on rodents. It is a severe form of bacterial infection that has life threatening consequences. In cases of failure to initiate prompt treatment, bubonic plague can cause mortality in about 2/3rd of the individuals infected with the disease.

Previously, bubonic plague was also referred to as plague, but the former is specifically caused due to an infection that enters the skin and passes through the lymphatics. If humans are bitten by infected flea, it leads to development of swelling of the lymph nodes. Through the bite, the bacteria gains entry through the skin, following which it travels through the lymph nodes, giving rise to an array of symptoms [1].

Patient Information

Definition

Bubonic plague is a bacterial disease characterized by development of buboes in the armpits, neck and groin region, hence the name bubonic plague. It is a disease which can cause death in the affected population, if prompt treatment is not initiated. The disease primarily occurs due to infected fleas which reside on rodents, and bite the humans.

Cause

The bacteria Yersinia pestis causes bubonic plague. The disease is spread through infected fleas which harbor on rodents, and bite the human, eventually gaining entry into the system. The bacteria enter the system through the skin and travel through the lymphatics leading to swelling of the lymph glands.

Symptoms

Development of buboes in the groin, neck or the armpit region is the characteristic symptom of bubonic plague. The area of the insect bite is where the bubo develops. Individuals may also experience pain in the area of the insect bite prior to the occurrence of bubo. In addition, affected individuals also suffer from fever, along with chills, malaise, headache and muscle ache.

Diagnosis

Diagnosis of bubonic plague is made through a preliminary physical examination of the bubo. In addition, a rapid diagnostic tool known as immunofluorescence of the body fluids has been developed which enables analyzing the presence of small amounts of bacteria within 15 minutes.

Treatment

A strong antibiotic regime is helpful for treating bubonic plague. If antibiotics are given when the primary signs appear, then individuals can recover fully from the disease.

References

Article

  1. Prentice MB, Rahalison L. Plague. Lancet. Apr 7 2007;369(9568):1196-207. 
  2. Weniger BG, Warren AJ, Forseth V, et al. Human bubonic plague transmitted by a domestic cat scratch. JAMA 1984; 251:927.
  3. Ratsitorahina M, Chanteau S, Rahalison L, et al. Epidemiological and diagnostic aspects of the outbreak of pneumonic plague in Madagascar. Lancet 2000; 355:111.
  4. MMWR. Human plague--United States, 1993-1994. MMWR Morb Mortal Wkly Rep. Apr 8 1994;43(13):242-6.
  5. Centers for Disease Control and Prevention (CDC). Bubonic and pneumonic plague - Uganda, 2006. MMWR Morb Mortal Wkly Rep 2009; 58:778.
  6. Inglesby TV, Dennis DT, Henderson DA. Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA. May 3 2000;283(17):2281-90.
  7. Chanteau S, Rahalison L, Ralafiarisoa L, Foulon J, Ratsitorahina M, Ratsifasoamanana L. Development and testing of a rapid diagnostic test for bubonic and pneumonic plague. Lancet. Jan 18 2003;361(9353):211-6.
  8. Mwengee W, Butler T, Mgema S, et al. Treatment of plague with gentamicin or doxycycline in a randomized clinical trial in Tanzania. Clin Infect Dis 2006; 42:614.
  9. Rahalison L, Vololonirina E, Ratsitorahina M. Diagnosis of bubonic plague by PCR in Madagascar under field conditions. J Clin Microbiol. Jan 2000;38(1):260-3.
  10. Jefferson T, Demicheli V, Pratt M. Vaccines for preventing plague. Cochrane Database Syst Rev. 2000;(2):CD000976.

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Last updated: 2019-07-11 22:00