PLAGUE

INTRODUCTION
The plague, also known as the Black Death, is a highly infectious and often fatal disease caused by the
bacterium Yersinia pestis. It is primarily spread by fleas that live on rats and other rodents. When an infected
flea bites a human, the bacteria can enter the bloodstream and cause a range of symptoms, including fever,
chills, and painful swelling of the lymph nodes.
The plague has been responsible for several devastating pandemics throughout history. The most infamous
pandemic occurred in the 14th century and is estimated to have killed between 75 and 200 million people in
Eurasia, representing a significant portion of the world's population at the time. This pandemic, known as the
Black Death, led to widespread social and economic upheaval and had a lasting impact on European society.

DEFINITION
According to the World Health Organization (WHO), the plague is "a zoonotic disease caused by
Yersinia pestis, a bacterium usually found in small mammals and their fleas. It is transmitted between
animals and humans through the bite of infected fleas, direct contact with infected tissues, or inhalation of
infected respiratory droplets."
OR
The Centers for Disease Control and Prevention (CDC) describes the plague as "an infectious disease
caused by the bacterium Yersinia pestis. It affects humans and other mammals, and can be transmitted to
humans through the bites of infected fleas, handling of infected animals, or inhalation of droplets from
infected animals or humans."

EPIDEMIOLOGY
The epidemiology of the plague can be described in terms of its distribution, transmission, and incidence.
 Distribution: The plague is primarily found in parts of Africa, Asia, and the Americas. The majority of
cases occur in sub-Saharan Africa, particularly in Madagascar, where outbreaks are reported almost
every year. Other countries with reported cases of the plague include Peru, Bolivia, China, and India.
 Transmission: The plague is transmitted to humans through the bite of infected fleas, which usually
live on rats, mice, and other rodents. Humans can also become infected by handling infected animals or
inhaling respiratory droplets from infected individuals. Person-to-person transmission is rare.
 Incidence: According to the World Health Organization (WHO), there were 3,248 cases of the plague
reported worldwide between 2010 and 2015, resulting in 584 deaths. The actual number of cases may be
higher, as many cases go unreported. The majority of cases are bubonic plague, which affects the lymph
nodes, but other forms of the disease, such as septicemic and pneumonic plague, can also occur.
Outbreaks of the plague are typically sporadic and localized, although they can be widespread during
epidemics.

TYPES
There are three main types of plague, which differ in their clinical presentation and mode of transmission:
 Bubonic plague: This is the most common form of plague and is characterized by the sudden onset of
fever, chills, weakness, and painful swelling of the lymph nodes (called buboes). Bubonic plague is
usually transmitted to humans through the bites of infected fleas that live on rats, mice, and other
rodents. It can also be transmitted through handling or consuming infected animal tissue.
 Septicemic plague: This occurs when the bacteria spread throughout the bloodstream, causing a severe
infection. Septicemic plague can be caused by the same bacteria that cause bubonic plague or it can be a
primary infection. It can be transmitted through handling or consuming infected animal tissue, or it can
develop as a complication of bubonic plague. Symptoms of septicemic plague include fever, chills,
abdominal pain, vomiting, diarrhea, and bleeding under the skin or other organs.
 Pneumonic plague: This is the most severe form of plague and occurs when the bacteria infect the
lungs. Pneumonic plague can be transmitted through the air, either by inhaling respiratory droplets from
infected individuals or by handling infected animal tissue. It can cause severe respiratory symptoms,
including cough, chest pain, and difficulty breathing. Pneumonic plague can be a complication of
bubonic or septicemic plague if the bacteria spread to the lungs.

INCUBATION PERIOD
The incubation period of the plague can vary depending on the form of the disease and the individual's
immune response. Generally, the incubation period is 2 to 10 days after exposure to the bacterium Yersinia
pestis, although it can be longer in some cases.
 Bubonic plague, which is the most common form of the disease, typically has an incubation period of
2 to 6 days. Symptoms usually appear suddenly and include fever, chills, weakness, and painful
swelling of the lymph nodes (called buboes).
 Septicemic plague, which occurs when the bacteria spread throughout the bloodstream, has a shorter
incubation period of 1 to 4 days. Symptoms can include fever, chills, abdominal pain, vomiting,
diarrhea, and bleeding under the skin or other organs.
 Pneumonic plague, which is the most severe form of the disease and can be transmitted through the
air, has an even shorter incubation period of 1 to 3 days. Symptoms include fever, cough, chest pain,
and difficulty breathing.
CLINICAL MANIFESTATION
The clinical manifestations of the plague can vary depending on the form of the disease, but common
symptoms include:
Bubonic plague:
 Sudden onset of fever and chills
 Headache and muscle aches
 Painful swelling of lymph nodes, usually in the groin, armpit, or neck
 Fatigue and weakness
 Rapid heart rate
 Gastrointestinal symptoms, such as nausea, vomiting, and diarrhea
Septicemic plague:
 Rapid onset of fever and chills
 Abdominal pain, vomiting, and diarrhea
 Low blood pressure and shock
 Bleeding under the skin or other organs
 Disseminated intravascular coagulation (DIC), a condition that causes blood clots to form throughout
the body, leading to organ damage and failure
Pneumonic plague:
 Sudden onset of fever, chills, and cough
 Chest pain and shortness of breath
 Rapid breathing
 Cough with bloody or watery sputum
 Cyanosis (blue coloration) of the skin and lips.

DIAGNOSTIC EVALUATION
The diagnostic evaluation of plague typically includes a combination of clinical evaluation, laboratory tests,
and imaging studies. Here are some of the common methods used for diagnosing the disease:

 Clinical evaluation: The doctor will evaluate the patient's symptoms, medical history, and possible
exposure to the bacterium Yersinia pestis. Look for signs of lymph node swelling, skin lesions, and
respiratory symptoms, which can help differentiate between the various forms of the disease.
 Laboratory tests for plague may include:
 1. Culture: This involves collecting a sample of blood, sputum, or other bodily fluid and growing it
in a laboratory setting to see if Yersinia pestis bacteria are present.
2. Polymerase chain reaction (PCR): This is a sensitive laboratory technique that can detect the
DNA of Yersinia pestis bacteria in blood, sputum, or other bodily fluid.
3. Serology: This involves testing a blood sample for antibodies produced by the immune system in
response to Yersinia pestis. Serology tests may be used to confirm a diagnosis of plague, but they
are not useful for early diagnosis since it takes time for the immune system to produce antibodies.
4. Immunofluorescence assay (IFA): This test uses fluorescent-labeled antibodies to detect the
presence of Yersinia pestis in a blood or tissue sample.
 Imaging studies: Chest X-rays or computed tomography (CT) scans may be used to evaluate the lungs
for signs of pneumonic plague.

TREATMENT
The treatment of plague involves prompt administration of antibiotics, usually in combination with
supportive care. The choice of antibiotics and duration of treatment depend on the form of the disease and
the severity of symptoms.

Pharmacological and Non-Pharmacological

 Bubonic plague: Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are

usually effective in treating bubonic plague. Treatment is typically continued for 10-14 days or until the
patient has been afebrile for at least 48 hours.
 Septicemic plague: Treatment for septicemic plague may include antibiotics such as streptomycin,
gentamicin, doxycycline, or ciprofloxacin. Supportive care, such as fluid replacement, oxygen therapy,
and treatment for shock, may also be necessary.
 Pneumonic plague: Pneumonic plague is a medical emergency and requires immediate treatment with
antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin. Treatment should be
initiated as soon as possible, ideally within 24 hours of symptom onset.
 Supportive care:
Supportive care plays an important role in the management of patients with plague, particularly those
with severe or complicated disease. Here are some examples of supportive care measures that may be
necessary:
1. Fluid replacement: Patients with plague may experience dehydration due to fever, vomiting, and
diarrhea. Intravenous fluids may be necessary to maintain hydration and electrolyte balance.
 2. Oxygen therapy: Patients with pneumonic plague may require supplemental oxygen to improve
oxygenation and alleviate respiratory distress.
3. Treatment for shock: Patients with septicemic plague may develop septic shock, which requires
aggressive management with intravenous fluids, vasopressors, and other supportive measures.
4. Wound care: Patients with bubonic plague may require wound care to prevent secondary
bacterial infections of the skin lesions.
5. Pain management: Patients with plague may experience pain due to lymph node swelling, skin
lesions, and other symptoms. Pain medications may be necessary to provide symptomatic relief.

PREVENTION
Preventing the spread of plague involves measures to control the disease in animals and prevent transmission
to humans. Here are some steps that can be taken to prevent plague:

 Control rodent populations: Plague is commonly spread by fleas that infest rodents, so controlling
rodent populations is an important step in preventing the spread of the disease. This can be done through
the use of rodent-proof containers for food and waste, removal of potential rodent habitats, and trapping
or poisoning of rodents.
 Practice good hygiene: Wash hands frequently with soap and water, especially after handling animals
or potentially contaminated objects. Cover your mouth and nose when coughing or sneezing.
 Use insecticides: Insecticides can be used to control flea populations in areas where plague is known to
be present.
 Vaccination: A vaccine is available for high-risk individuals such as laboratory workers and those who
work with animals or in areas where the disease is endemic.
 Avoid contact with sick animals: It's important to avoid contact with sick or dead rodents or other
animals that may be carrying the disease.
 Seek medical attention promptly: If anyone develops symptoms of plague, seek medical attention
immediately. Early diagnosis and treatment can greatly improve the chances of survival and prevent the
spread of the disease to others.