Bubonic Plague is an acute, severe infectious disorder caused by the bacterium (bacillus) Yersinia Pestis. These bacteria can be carried by small wild rodents, other wild animals or even household pets. The disease can be transmitted to humans through the bites of fleas or through direct contact with infected animal tissues. The disorder is most common in Southeast Asia, but it also occurs in some areas of the United States. Major symptoms include an abrupt onset with chills, fever, and enlarged lymph nodes (buboes). Treatment must start immediately to avoid life-threatening complications. A milder form of Bubonic Plague, Pestis Minor, usually resolves in approximately a week with appropriate treatment. Interest in Bubonic Plague has heightened, in recent years, by the awareness of its potential use as an agent of biological warfare.
Bubonic Plague usually begins abruptly with chills followed by a high fever and swollen, painful lymph nodes in the groin, thigh, underarm (axilla), and/or neck. Skin overlying affected areas may be smooth and reddened, but usually does not feel hot. Small skin lesions, often appearing to be either water-filled blisters or thick coagulated crusts, may develop at the sites of flea bites. A contagious form of pneumonia, with lesions in the lungs, may also occur. The pulse may be rapid and blood pressure may be low (hypotension). Individuals with Bubonic Plague may become restless, confused, delirious and/or uncoordinated. Some individuals may experience nausea, vomiting, diarrhea, and/or abdominal pain. The lymph nodes may begin to form pus (suppurate) during the second week. Complications may include blood poisoning (septicemia), pneumonia, or meningitis (inflammation of the tissue surrounding the brain and spinal cord).
Pestis Minor is a mild form of Bubonic Plague. It is characterized by lymph node inflammation (lymphadenitis), fever, headache, and a feeling of exhaustion. With appropriate and timely treatment, this condition usually subsides in less than a week.
Bubonic Plague is caused by the bacteria (bacillus) Yersinia Pestis. Certain areas of the United States, southeast Asia, and some other parts of the world are at risk for outbreaks even today. Small wild rodents such as rats, mice, squirrels, prairie dogs, chipmunks, deer mice, rabbits, and other wild animals, may carry the infection. Fleas bites transmit the bacteria to other animals or humans. Direct contact with infected animal tissues can also spread this disorder. In addition, the infection can be spread among humans after an infected individual develops lesions in the lungs.
Bubonic Plague affects males and females of all ages in equal numbers. Bubonic Plague usually affects individuals in rural, open areas where contact with wild rodents is common. Small "epidemics" have occurred mostly in the southwestern sections of the United States such as Arizona, New Mexico, southern Colorado, and California. Areas of the world such as southeast Asia and southern Africa are particularly at risk for outbreaks of this disorder. Between 1980 and 1994, there were nearly 19,000 cases reported worldwide; 229 cases were in the United States. In 1996, five cases were reported. However, the exact incidences of Bubonic Plague is difficult to determine because it is frequently misdiagnosed.
Symptoms of the following disorders can be similar to those of Bubonic Plague. Comparisons may be useful for a differential diagnosis:
Typhoid Fever is an acute infectious disorder caused by the bacteria known as Salmonella Typhi. This disorder is characterized by a continuous fever, rising in a step-like curve during the first week, great physical and mental depression, an eruption of rose-colored spots on the chest and abdomen, abdominal swelling (meteorism), diarrhea, and sometimes intestinal bleeding or perforation of the bowel. An average attack of Typhoid Fever lasts about four weeks, although some episodes may be shorter, and relapses can occur. Lesions are located chiefly in the lymph follicles of the intestines, the abdominal cavity lining (mesenteric) glands, and the spleen. Treatment with the drug chloramphenicol is usually effective, but preventive measures should be taken by travelers to high risk areas in order to avoid the disease.
Primary Pneumonic Plague is a form of plague with a two- to three-day incubation period, followed by abrupt onset of high fever, chills, irregular heartbeat, and often, severe headaches. Coughing, which is not prominent initially, usually develops within twenty-four hours. Sputum contains mucous at first, followed by the presence of specks of blood. Later, it becomes uniformly pink or bright red and foamy. Breathing difficulties (tachypnea and dyspnea) are present. Chest X-rays show a rapidly progressing pneumonia. Untreated patients may die within forty-eight hours.
Septicemic Plague usually occurs with Bubonic Plague as an acute, suddenly occurring (fulminant) disorder. Live bacteria and large concentrations of other toxins are found in the circulating blood. This disorder may be fatal before lymph node or lung symptoms predominate.
Diagnosis The diagnosis of Bubonic Plague may be confirmed by specialized laboratory test and characteristic physical findings. All cases of Bubonic Plague must be reported to the Health Department and the World Health Organization.
Treatment Treatment of Bubonic Plague must begin as soon as possible to avoid complications. Since this disorder resembles a number of flu-like conditions, anyone who develops these symptoms after contact with small animals, (and in particular, rodents) should be tested immediately. The antibiotic drug streptomycin is the treatment of choice. Alternatives may include aminoglycosides or tetracycline drugs. If meningitis (inflammation of the tissue surrounding the brain and spinal cord) has developed, the drug chloramphenicol may be used. Routine care to avoid additional infection is necessary. When pneumonia has developed, patients should be kept isolated. People who have been exposed to Bubonic Plague may take tetracycline drugs prophylactically for six days. There is a new strain of Yersinia Pestis (named 17/19) that may be resistant to antibiotics. Travelers to countries where the risk of contracting Bubonic Plague is high, such as southeast Asia or southern Africa should be immunized.
Additional antibiotics are being tested as possible treatments for Bubonic Plague.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
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