BUBONIC PLAGUE is one of three types of bacterial infection caused by Yersinia pestis . One to seven days after exposure to the bacteria, flu like symptoms develop. These include fever , headaches , and vomiting. Swollen and painful lymph nodes occur in the area closest to where the bacteria entered the skin. Occasionally the swollen lymph nodes may break open.
The three types of plague are the result of the route of infection: bubonic plague, septicemic plague , and pneumonic plague . Bubonic plague is mainly spread by infected fleas from small animals . It may also result from exposure to the body fluids from a dead plague infected animal. In the bubonic form of plague, the bacteria enter through the skin through a flea bite and travel via the lymphatic vessels to a lymph node , causing it to swell. Diagnosis is made by finding the bacteria in the blood, sputum , or fluid from lymph nodes.
Prevention is through public health measures such as not handling dead animals in areas where plague is common. Vaccines have not been found to be very useful for plague prevention. Several antibiotics are effective for treatment including streptomycin , gentamicin , and doxycycline . Without treatment it results in the death of 30% to 90% of those infected. Death, if it occurs, is typically within ten days. With treatment the risk of death is around 10%. Globally there are about 650 documented cases a year which result in ~120 deaths. The disease is most common in Africa.
The plague is believed to be the cause of the Black Death that swept through Asia, Europe, and Africa in the 14th century and killed an estimated 50 million people. This was about 25% to 60% of the European population. Because the plague killed so many of the working population, wages rose due to the demand for labor. Some historians see this as a turning point in European economic development. The term bubonic plague is derived from the Greek word βουβών, meaning "groin". The term "buboes " is also used to refer to the swollen lymph nodes.
* 1 Signs and symptoms * 2 Cause * 3 Diagnosis * 4 Treatment
* 5 History
* 5.1 First outbreak * 5.2 Second outbreak * 5.3 Traditional treatment * 5.4 Third outbreak
* 6 Society and culture
* 6.1 Biological warfare
* 7 See also * 8 References * 9 Further reading * 10 External links
SIGNS AND SYMPTOMS
Acral necrosis of the nose, the lips, and the fingers and residual ecchymoses over both forearms in a person recovering from bubonic plague that disseminated to the blood and the lungs. At one time, the person's entire body was ecchymotic .
The best-known symptom of bubonic plague is one or more infected, enlarged, and painful lymph nodes, known as buboes . After being transmitted via the bite of an infected flea, the Y. pestis bacteria become localized in an inflamed lymph node where they begin to colonize and reproduce. Buboes associated with the bubonic plague are commonly found in the armpits, upper femoral, groin and neck region. Acral gangrene (i.e., of the fingers, toes, lips and nose) is another common symptom.
Because of its bite-based mode of transmission, the bubonic plague is often the first of a progressive series of illnesses. Bubonic plague symptoms appear suddenly a few days after exposure to the bacterium. Symptoms include:
* General ill feeling (malaise )
* High fever (39 °C; 102 °F)
* Muscle cramps
Other symptoms include heavy breathing, continuous vomiting of blood (hematemesis ), aching limbs, coughing, and extreme pain caused by the decay or decomposition of the skin while the person is still alive. Additional symptoms include extreme fatigue, gastrointestinal problems, lenticulae (black dots scattered throughout the body), delirium, and coma .
Oriental rat flea (Xenopsylla cheopis) infected with the Yersinia pestis bacterium which appears as a dark mass in the gut. The foregut of this flea is blocked by a Y. pestis biofilm ; when the flea attempts to feed on an uninfected host , Y. pestis from the foregut is regurgitated into the wound, causing infection .
Y. pestis bacilli can resist phagocytosis and even reproduce inside
phagocytes and kill them. As the disease progresses, the lymph nodes
can haemorrhage and become swollen and necrotic .
Laboratory testing is required in order to diagnose and confirm plague. Ideally, confirmation is through the identification of Y. pestis culture from a patient sample. Confirmation of infection can be done by examining serum taken during the early and late stages of infection . To quickly screen for the Y. pestis antigen in patients, rapid dipstick tests have been developed for field use.
Several classes of antibiotics are effective in treating bubonic plague. These include aminoglycosides such as streptomycin and gentamicin , tetracyclines (especially doxycycline ), and the fluoroquinolone ciprofloxacin . Mortality associated with treated cases of bubonic plague is about 1–15%, compared to a mortality of 40–60% in untreated cases.
People potentially infected with the plague need immediate treatment and should be given antibiotics within 24 hours of the first symptoms to prevent death. Other treatments include oxygen, intravenous fluids, and respiratory support. People who have had contact with anyone infected by pneumonic plague are given prophylactic antibiotics. Using the broad-based antibiotic streptomycin has proven to be dramatically successful against the bubonic plague within 12 hours of infection.
See also: Timeline of plague
Main article: Plague of Justinian
The first recorded epidemic affected the Eastern Roman Empire
(Byzantine Empire) and was named the
Plague of Justinian after emperor
Justinian I , who was infected but survived through extensive
treatment. The pandemic resulted in the deaths of an estimated 25
million (6th century outbreak) to 50 million people (two centuries of
recurrence). The historian
Black Death and
Second plague pandemic Citizens
Late Middle Ages (1340–1400) Europe experienced the most
deadly disease outbreak in history when the Black Death, the infamous
pandemic of bubonic plague, hit in 1347, killing a third of the human
population. Some historians believe that society subsequently became
more violent as the mass mortality rate cheapened life and thus
increased warfare, crime, popular revolt, waves of flagellants, and
Black Death originated in or near
There were many ethno-medical beliefs for avoiding the Black Death. One of the most famous was that by walking around with flowers in or around their nose people would be able to "ward off the stench and perhaps the evil that afflicted them". People believed the plague to be a punishment from God, and that the only way to be rid of the plague was to be forgiven by God. One such method used was to carve the symbol of the cross onto the front door of a house with the words "Lord have mercy on us".
Pistoia , a city in Italy, went as far as enacting rules and regulations on the city and its inhabitants to keep it safe from the Black Death. The rules stated that no one was allowed to visit any plague-infected area and if they did they were not allowed back into the city. Some other rules were that no linen or woollen goods were to be imported into the city and no corpses were to be buried in the city. Despite strict enforcement of the rules, the city eventually became infected. People who were not infected with the plague gathered in groups and stayed away from the sick. They ate and drank with limited food and water and were not even allowed oral communication because it was believed that merely talking with one another increased the chance of passing on the disease.
While Europe was devastated by the disease, the rest of the world fared much better. In India, population rose from a population of 91 million in 1300, to 97 million in 1400, to 105 million in 1500. Sub-Saharan Africa remained largely unaffected by the plagues.
The next few centuries were marked by several localized or regional outbreaks of lesser severity. The Great Plague of Milan (1629–1631), the Great Plague of Seville (1647), the Great Plague of London (1665–1666), the Great Plague of Vienna (1679), Great Baltic plague (1708–1712), the Great Plague of Marseille (1720), the Great Plague of 1738 , and Caragea\'s Plague (1813–1814) were the last major outbreaks of the bubonic plague in Europe.
Main article: Miasma theory
Medieval doctors thought the plague was created by air corrupted by humid weather, decaying unburied bodies, and fumes produced by poor sanitation. The recommended treatment of the plague was a good diet, rest, and relocating to a non-infected environment so the individual could get access to clean air. This did help, but not for the reasons the doctors of the time thought. In actuality, because they recommended moving away from unsanitary conditions, people were, in effect, getting away from the rodents that harbored the fleas carrying the infection. However, this also helped to spread the infection to new areas previously non-infected.
Main article: Third plague pandemic Directions for searchers, Poona (now Pune) plague of 1897
The plague resurfaced for a third time in the mid-19th century. Like
the two previous outbreaks, this one also originated in
From China, the plague spread to the
In 1899, the plague reached the islands of
Australia suffered 12 major plague outbreaks between 1900 and 1925 originating from shipping. Research by Australian medical officers Thompson , Armstrong and Tidswell contributed to understanding the spread of Yersinia pestis to humans by fleas from infected rats.
According to the
World Health Organization
SOCIETY AND CULTURE
See also: Black Death in medieval culture
The scale of death and social upheaval associated with plague
outbreaks has made the topic prominent in a number of historical and
fictional accounts since the disease was first recognized. The Black
Death in particular is described and referenced in numerous
contemporary sources , some of which, including works by Chaucer ,
Boccaccio , and
Later works, such as
Some of the earliest instances of biological warfare were said to have been products of the plague, as armies of the 14th century were recorded catapulting diseased corpses over the walls of towns and villages to spread the pestilence.
Later, plague was used during the
Second Sino-Japanese War
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* ICD -10 : A20.0 * ICD -9-CM