Patient's Complete Guide to Plague

Overview of Plague

Plague or طاعون is a contagious bacterial infection that can be transmitted by infected fleas. Yersinia pestis is a bacterium responsible for plague infection. This bacterium is commonly present in small rodents. If a flea bites the infected rodent it becomes infectious and later transmits the infection to humans. Humans handling infected animals can also develop plague infections.

Plague can occur in three forms; bubonic, pneumonic and systemic. Among these pneumonic is the most fatal one but can be treated at early stages. 

Plague Occurrence

Globally, from 2010-2015, approximately 3248 cases of plague were reported with 584 deaths.

Historically, the plague caused large pandemics with high death rates. In the 14th century, it was termed as “Black Death” because it caused 50 million deaths in Europe. These days it can be prevented by proper precautions. Its treatment has also become possible by the advent of new standard antibiotics.

In Africa, Asia, and South America various epidemics of plague have occurred. But after 1990, most cases were reported in Africa.

Signs and Symptoms of Plague

Infected people typically develop flu-like symptoms within 2-6 days of infection. Symptoms of all three forms of plague are different from each other. 

Bubonic Plague Symptoms

Symptoms of bubonic plague usually start after 2-6 days of infection. They may include:

  • Fever and chills
  • Headache
  • Muscle pain
  • General weakness
  • Seizures
  • Swollen lymph glands called buboes

Septicemic Plague Symptoms

Septicemic plague symptoms often appear within 2-7 days after exposure, but septicemic plague can be fatal and cause death before symptoms even appear. Symptoms may include:

  • Abdominal pain
  • Fever and chills
  • Diarrhoea
  • Nausea and vomiting
  • Bleeding (blood may not be able to clot)
  • Extreme weakness
  • Shock
  • Skin turning black (gangrene)

Pneumonic Plague Symptoms

Pneumonic plague symptoms usually appear immediately after exposure to the bacteria. These symptoms can be:

  • Trouble breathing
  • Fever
  • Chest pain
  • Cough
  • Overall weakness
  • Headache
  • Bloody sputum (saliva and mucus or pus from the lungs)

Types of Plague

There are three types of plague depending upon the part of the body that is involved.

  • Bubonic Plague: This is the most common type of plague caused by infected fleas. Yersinia pestis is the parasite responsible for bubonic plague. It enters the lymphatic system where it replicates. It causes the inflammation of lymph nodes that become swollen and painful. These swollen lymph nodes are called Bubo, after which the plague is named.                                                                                                                                                                                 At an advanced stage, lymph nodes are filled with pus and the infection spreads. When it reaches the lungs it causes pneumonic plague. Bubonic plague is not transmitted from human to human.
  • Pneumonic Plague: Pneumonic plague is the deadliest form of plague. Its incubation time is 24 hours. It is spread by the droplets of infected people. If its diagnosis and treatment are not proper it can be fatal. However, its recovery rate is high as compared to other plagues if treated at early stages.

Causes of Plague

The plague is caused by a bacterium, Yersinia pestis. The bacterium is transmitted to humans when an infected flea bites a person. Yersinia pestis can infect various hosts such as:

  • Rats
  • Mice
  • Squirrels
  • Rabbits
  • Prairie dogs
  • Chipmunks
  • Voles

The bacteria can also infect by the exposure of skin cuts to the infected blood. Domestic dogs and cats are usually infected by the bites of fleas.

Pneumonic plague, in which lungs are affected, is transmitted by inhaling infectious droplets released into the air by a sick animal or person.

Risk Factors of Plague

Infected people typically develop flu-like symptoms within 2-6 days of infection. Symptoms of all three forms of plague are different from each other. 

Bubonic Plague Symptoms

Symptoms of bubonic plague usually start after 2-6 days of infection. They may include:

  • Fever and chills
  • Headache
  • Muscle pain
  • General weakness
  • Seizures
  • Swollen lymph glands called buboes

Septicemic Plague Symptoms

Septicemic plague symptoms often appear within 2-7 days after exposure, but septicemic plague can be fatal and cause death before symptoms even appear. Symptoms may include:

  • Abdominal pain
  • Fever and chills
  • Diarrhoea
  • Nausea and vomiting
  • Bleeding (blood may not be able to clot)
  • Extreme weakness
  • Shock
  • Skin turning black (gangrene)

Pneumonic Plague Symptoms

Pneumonic plague symptoms usually appear immediately after exposure to the bacteria. These symptoms can be:

  • Trouble breathing
  • Fever
  • Chest pain
  • Cough
  • Overall weakness
  • Headache
  • Bloody sputum (saliva and mucus or pus from the lungs)

Prevention

Plague can be prevented by:

  • Avoiding contact with infected animals
  • Avoiding direct contact with infected person fluids and used tissue papers

Following proper measures, while handling infected samples

Diagnosis

If plague is suspected after physical examination your doctor may recommend tests for the identification of the Yersinia pestis.

  • Blood: If you have the septicemic plague, the bacteria will be present in your blood. For this purpose, blood tests will be performed for the confirmation of Yersinia pestis.
  • Aspiration: If you have buboes/typical plague in which the lymph nodes are swollen aspiration will be performed to take fluid samples from the buboes.
  • Lungs: To diagnose pneumonic plague, your doctor may take sputum or fluid from your nose or mouth by using a thin, flexible tube called an endoscope. This procedure is called endoscopy.

Treatment of Plague | When to Consult a Doctor

Depending upon the type of plague, it is treated accordingly. Let’s have a look:

Medications

If you are diagnosed plague positive, your doctor will recommend you to be admitted to a hospital. Following antibiotics are prescribed for the treatment of plague:

  • Gentamicin
  • Ciprofloxacin (Cipro)
  • Doxycycline (Monodox, Vibramycin, others)
  • Moxifloxacin (Avelox)
  • Levofloxacin
  • Chloramphenicol

If you begin to feel ill after travelling from a region where plague is common seek immediate medical attention. You have to be treated as soon as possible to prevent serious complications or death.

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