bubonic plague

A contagious, often fatal epidemic disease caused by the bacterium Yersinia (syn. Pasteurella) pestis, transmitted from person to person or by the bite of fleas from an infected rodent, especially a rat, and characterized by chills, fever, vomiting, diarrhea, and the formation of buboes.

A concern of health and defense officials is the possible deliberate introduction of plague—or the exploitation of plague—as a terrorist weapon. Plague causing microorganisms are highly lethal, highly transmissible, and relatively easy to develop as terrorist weapons.

Bubonic plague is transmitted via fleas infected with Yersinia pestis. Pneumonic plague results from plague bacterium investing lung tissue. Pneumonic plague exhibits an airborne form of transmission. Infection occurs from breathing aerosolized bacteria. Untreated pneumonic plague is highly lethal.

Bubonic plague is a disease that is typically passed from rodents to other animals and humans via the bite of a flea. The flea acquires the bacterium that causes the disease as it lives on the skin of the rodent. Humans can also acquire the disease by direct contact with infected tissue.

The bacterium Pasteurella pestis is also known as Yersinia pestis, after one of its co-discoverers, Alexandre Yersin.

Prior to 1970, both United States and Soviet biological weapons programs developed techniques that enabled weapons developers to aerosolize plague particles.

Bubonic plague is named because of the symptoms. The bacterial infection produces a painful swelling of the lymph nodes. These are called buboes. Often the first swelling is evident in the groin. During the Middle Ages, a pandemic of bubonic plague was referred to as the Black Death, because of the blackening of the skin due to the dried blood that accumulated under the skin's surface.

The bubonic plague has been a significant cause of misery and death throughout recorded history. The Black Death is only one of many epidemics of plague that extended back to the beginning of recorded history. The first recorded outbreak of bubonic plague was in 542–543. This plague destroyed the attempts of the Roman emperor of the day to re-establish a Roman empire in Europe. This is only one example of how bubonic plague has changed the course of history.

The plague of London in 1665 killed over 17,000 people (almost twenty percent of the city's population). This outbreak was quelled by a huge fire that destroyed most of the city.

The disease remains present to this day. In North America, the last large epidemic occurred in Los Angeles in 1925. With the advent of the antibiotic era, bubonic plague has been controlled in the developed world. However, sporadic cases (e.g., 10 to 15 cases each year) still occur in the western United States. In less developed countries (e.g., in Africa, Bolivia, Peru, Ecuador, Brazil) thousands of cases are reported each year.

The infrequency of bubonic plague outbreaks does not mean the disease disappears altogether. Rather, the disease normally exists in what is called an enzootic state. That is, a few individuals of a certain community (e.g., rodents) harbor the disease. Sometimes, however, environmental conditions cause the disease to spread through the carrier population, causing loss of life. As the rodent populations dies, the fleas that live on them need to find other food sources. This is when the interaction with humans and non-rodent animals can occur. Between outbreaks, Yersinia pestis infects rodents without causing much illness. Thus, the rodents become a reservoir of the infection.

Symptoms of infection in humans begin within days after contamination with the plague bacterium. The bacteria enter the bloodstream and travel to various organs (e.g., kidney, liver, spleen, lungs) as well as to the brain. Symptoms include shivering, nausea with vomiting, headache, intolerance to light, and a whitish-appearing tongue. Buboes then appear, followed by rupture of blood vessels. The released blood can coagulate and turn black.

If the infection is untreated, the death rate in humans approaches 75%. Prompt treatment most often leads to full recovery and a life-long immunity from further infection. Prevention is possible, since a vaccine is available. Unfortunately, the vaccine is protective for only a few months. Use of the vaccine is usually reserved for those who will be at high risk for acquiring the bacterial infection (e.g., soldiers, travelers to an outbreak region). Antibiotics such as tetracycline or sulfonamide are used more commonly as a precaution for those who might be exposed to the bacterium. Such use of antibiotics should be stopped once the risk of infection is gone, to avoid the development of resistance in other bacteria resident in the body.

The most effective way to prevent bubonic plague is the maintenance of adequate sanitary conditions. This acts to control the rodent population, especially in urban centers.

In 1970, a World Health Organization study concluded that deliberate dissemination of 110 lbs (50 kg) of aerosolized Y pestis over a city with a population of approximately 5 million people could potentially result in 150,000 cases of pneumonic plague. Half of these cases would require advanced medical care and approximately 20% would be expected to perish.

Further Reading

Books

Campbell, G. L., and D. T. Dennis. "Plague and other Yersinia infections." In: D. L. Kasper, et al; eds. Harrison's Principles of Internal Medicine, 14th ed. New York: McGraw Hill, 1998.

Dennis, D. T., N. Gratz, J. D. Poland, and E. Tikhomirov. Plague Manual: Epidemiology, Distribution, Surveillance and Control. Geneva: World Health Organization, 1999.

Frist, W. H. When Every Moment Counts: What You Need to Know about Bioterrorism from the Senates Only Doctor. Lanham, MD: Rowman & Littlefield, 2002.

Henderson, D.A., and T.V. Inglesby. Bioterrorism: Guidelines for Medical and Public Health Management. Chicago: American Medical Association, 2002.

Inglesby, Thomas V. "Bioterrorist Threats: What the Infectious Disease Community Should Know about Anthrax and Plague." Emerging Infections 5. Washington, D.C.: American Society for Microbiology Press, 2001.

Periodicals

Kaufmann, A. F., M. I. Meltzer, and G. P. Schmid. "The Economic Impact of a Bioterrorist Attack: Are Prevention and Postattack Intervention Program Justifiable?" Emerging Infectious Diseases no. 3 (1997): 83–94.

A highly contagious disease, usually fatal, affecting the lymphatic system. The bubonic plague is caused by bacteria transmitted to humans by rat-borne fleas.

This article is about the disease in general. For information about the medieval European plague, see Black Death.

Bubonic plague
Classification and external resources
A person infected with bubonic plague
ICD-10	020.0
ICD-9	050
DiseasesDB	14226

Bubonic plague is the best known manifestation of the bacterial disease plague, caused by the Gram-negative bacterium Yersinia pestis (formerly known as Pasteurella pestis). It belongs to the family Enterobacteriaceae. The term "bubonic plague" was often used synonymously for plague, but it does in fact refer specifically to an infection that enters through the skin and travels through the lymphatics, as is often seen in flea-borne infections. Bubonic plague kills about half of infected patients in 3–7 days without treatment, and may be the Black Death that swept through Europe in the 1340s, killing tens of millions.^[1]

Contents 1 Pathology and transmission 2 Symptoms 3 History 4 Treatment 5 See also 6 Notes 7 Further reading

Pathology and transmission

The bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, Xenopsylla cheopis (the rat flea). The fleas are often found on rodents, such as rats and mice, and seek out other prey when their rodent hosts die. The bacteria form aggregates in the gut of infected fleas and this results in the flea regurgitating ingested blood, which is now infected, into the bite site of a rodent or human host. Once established, bacteria rapidly spread to the lymph nodes and multiply. Yersinia 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. Bubonic plague can progress to lethal septicemic plague in some cases. The plague is also known to spread to the lungs and become the disease known as the pneumonic plague. This form of the disease is highly infectious as the bacteria can be transmitted in droplets emitted when coughing or sneezing.

Symptoms

The most famous symptom of bubonic plague is painful, swollen lymph glands, called buboes. These are commonly found in the armpits, groin or neck. The bubonic plague was the first step of the ongoing plague. Two other forms of the plague, pneumonic and septicemic, resulted after a patient with the bubonic plague developed pneumonia or blood poisoning. The Pneumonic plague was the most infectious, as, unlike the bubonic or septicemic, it induced coughing, which allowed person-to-person spread.

Other symptoms include spots on the skin that are red at first and then turn black, heavy breathing, continuous blood vomiting, aching limbs, coughing, and terrible pain. The pain is usually caused by the actual decaying, or decomposing, of the skin while the person is still alive.

History

Main articles: Plague of Justinian, Black Death, and Third Pandemic

The deadly disease has claimed nearly 200 million lives (although there is some debate as to whether all of the plagues attributed to it are in fact the same disease). The first recorded epidemic ravaged the Byzantine Empire during the sixth century, and was named the Plague of Justinian after emperor Justinian I, who was infected but survived.

The most infamous and devastating instance of the plague was the Black Death, which killed a quarter to half of the population of Europe. The Black Death is thought to have originated in the Gobi Desert. Carried by the fleas on rats, it spread along trade routes and reached the Crimea in 1346. In 1347 it spread to Constantinople and then Alexandria, killing thousands every day, and soon arrived in Western Europe. It is thought that the name Black Death comes from the fact that the tissue turns a distinctive black color during necrosis, or from the general gloominess surrounding the plague.

The next few centuries were marked by several local outbreaks of lesser severity. The Great Plague of London, 1665–1666, and the Great Plague of Vienna, 1679, were the last major outbreaks of the bubonic plague in Europe.

Directions for searchers, Pune plague of 1897

The plague resurfaced in the mid-19th century; like the Black Death, the Third Pandemic began in Central Asia. The disease killed millions in China and India and then spread worldwide. The outbreak continued into the early 20th century. In 1897, Pune in British India, was severely affected by the outbreak. The government responded to the plague with a Committee system that used the military to perpetrate repression and tyranny as it tackled the pandemic. Nationalists publicly berated the government. On 22 June 1897, two young brahmins, the Chapekar brothers, shot and killed two British officers, the Committee chairman and his military escort. This act has been considered a landmark event in India's struggle for freedom as well as the worst violence against political authority seen in the world during the third plague pandemic.^[2]

Plague was used during the Second Sino-Japanese War as a bacteriological weapon by the Imperial Japanese Army. These weapons were provided by Shirō Ishii's units and used in experiments on humans before being used on the field. For example, in 1940, the Imperial Japanese Army Air Service bombed Ningbo with fleas carrying the bubonic plague.^[3] During the Khabarovsk War Crime Trials the accused, such as Major General Kiyashi Kawashima, testified that, in 1941, some 40 members of Unit 731 air-dropped plague-contaminated fleas on Changde. These operations caused epidemic plague outbreaks.^[4]

Treatment

In modern times, several classes of antibiotics are effective in treating bubonic plague. These include the aminoglycosides streptomycin and gentamicin, the tetracyclines tetracycline and doxycycline and the fluoroquinolone ciprofloxacin. Patients with plague in the modern era usually recover completely with prompt diagnosis and treatment.^{[citation needed]}

See also

• List of historical plagues
• Ring Around the Rosie; a popular urban legend says that the nursery rhyme details the plague. Some historians now regard this theory as baseless.
• Oh du lieber Augustin, song detailing the bubonic plague.

Notes

1. ^ Walker, Cameron (10 March, 2004). "Bubonic Plague Traced to Ancient Egypt". National Geographic News. http://news.nationalgeographic.com/news/2004/03/0310_040310_blackdeath.html. Retrieved 2 April, 2009. 
2. ^ Echenberg, Myron J. (2007). Plague Ports: The Global Urban Impact of Bubonic Plague, 1894–1901. New York: New York University Press. pp. 66–68. ISBN 0814722326. 
3. ^ Japan triggered bubonic plague outbreak, doctor claims, [1], http://www.scaruffi.com/politics/wwii.html, A time-line of World War II, Scaruffi Piero. Prince Tsuneyoshi Takeda and Prince Mikasa received a special screening by Shirō Ishii of a film showing imperial planes loading germ bombs for bubonic dissemination over Ningbo in 1940. (Daniel Barenblatt, A Plague upon Humanity, 2004, p.32.)
4. ^ Daniel Barenblatt, A Plague upon Humanity, 2004, pages 220–221.

Further reading

• Alexander, John T. (2003, 1980). Bubonic Plague in Early Modern Russia: Public Health and Urban Disaster. Oxford, UK; New York, NY: Oxford University Press. ISBN 0195158180. OCLC 50253204. 
• Carol, Benedict (1996). Bubonic Plague in Nineteenth-Century China. Stanford, CA: Stanford University Press. ISBN 0804726612. OCLC 34191853. 
• Biddle, Wayne (2002). A Field Guide to Germs (2nd Anchor Books ed.). New York: Anchor Books. ISBN 140003051X. OCLC 50154403. 
• Echenberg, Myron J. (2007). Plague Ports: The Global Urban Impact of Bubonic Plague, 1894-1901. New York, NY: New York University Press. ISBN 0814722326. OCLC 70292105. 
• Little, Lester K. (2007). Plague and the End of Antiquity: The Pandemic of 541-750. New York, NY: Cambridge University Press. ISBN 9780521846394. OCLC 65361042. 
• Scott, Susan, and C. J. Duncan (2001). Biology of Plagues: Evidence from Historical Populations. Cambridge, UK; New York, NY: Cambridge University Press. ISBN 0521801508. OCLC 44811929. 

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