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While exact figures are difficult to come by, some 1,000 to 2,000 cases of Bubonic Plague are reported worldwide each year. Though treatment, following and early and accurate diagnosis, cuts the number of fatalities greately, we just can't get away from this bug.

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Plague?

DefinitionPlague is a severe and potentially deadly bacterial infection.Alternative NamesBubonic plague; Pneumonic plague; Septicemic plagueCauses, incidence, and risk factorsPlague is caused by the bacteria Yersinia pestis.Rodents, such as rats, carry the disease. It is spread by their fleas.People can get the plague when they are bitten by a flea that carries the plague bacteria from an infected rodent. In rare cases, you may get the disease when handling an infected animal.A plague lung infection called pneumonic plague can spread from human to human. When someone with pneumonic plague coughs, tiny droplets carrying the bacteria move through the air. Anyone who breathes in these particles may catch the disease. An epidemic may be started this way.In the Middle Ages in Europe, massive plague epidemics killed millions of people. Plague can still be found in Africa, Asia, and South America.Today, plague is rare in the United States, but it has been known to occur in parts of California, Arizona, Colorado, and New Mexico.There three most common forms of plague are:Bubonic plague -- an infection of the lymph nodesPneumonic plague -- an infection of the lungsSepticemic plague -- an infection of the bloodThe time between being infected and developing symptoms is typically 2 to 7 days, but may be as short as 1 day for pneumonic plague.Risk factors for plague include a recent flea bite and exposure to rodents, especially rabbits, squirrels, or prairie dogs, or scratches or bites from infected domestic cats.SymptomsBubonic plague symptoms appear suddenly, usually after 2 - 5 days of exposure to the bacteria. Symptoms include:ChillsFeverGeneral ill feeling (malaise)HeadacheMuscle painSeizuresSmooth, painful lymph gland swelling called a buboCommonly found in the groin, but may occur in the armpits or neck, most often at the site of the infection (bite or scratch)Pain may occur in the area before the swelling appearsPneumonic plague symptoms appear suddenly, typically 2 - 3 days after exposure. They include:CoughDifficulty breathingFeverFrothy, bloody sputumPain in the chest when you breathe deeplySevere coughSepticemic plague may cause death even before its symptoms occur. Symptoms can include:Abdominal painBleeding due to blood clotting problemsDiarrheaFeverNauseaVomitingSigns and testsTests that may be done include:Blood cultureCulture of lymph node aspirate (fluid taken from an affected lymph node or bubo)Sputum cultureTreatmentPeople with the plague need immediate treatment. If treatment is not received within 24 hours of when the first symptoms occur, death may occur.Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague. Oxygen, intravenous fluids, and respiratory support usually are also needed.Patients with pneumonic plague should be strictly isolated from caregivers and other patients. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.Expectations (prognosis)Without treatment, about 50% of people with bubonic plague die. Almost all people with pneumonic plague die if not treated. Treatment reduces the death rate to 50%.Calling your health care providerCall your health care provider if you develop plague symptoms after exposure to fleas or rodents, especially if you live in or have visited an area where plague occurs.PreventionRat control and watching for the disease in the wild rodent population are the main measures used to control the risk of epidemics. A vaccination is available for high-risk workers, but its effectiveness is not clearly established.ReferencesDennis DT, Mead PS, Yersinia species, including plague. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 229.Gage KL. Plague and other Yersinia infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 333.Reviewed ByReview Date: 06/09/2011David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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