PLAGUE
SURAJ KUMAR
BSC NURSING 2ND YEAR
Introduction
Plague is an acute communicable disease primarily a zoonoses, caused by
Yersinia pestis, involving rodents and fleas. It is transmitted from rodents
to human beings by infected rat flea bites.
Definition
Plague is an infectious disease caused by the bacteria Yersinia pestis,
a zoonotic bacteria, usually found in small mammals and their fleas.
It is transmitted between animals through fleas. Humans can be
infected through: the bite of infected vector fleas.
Discovered by
The causative bacterium of plague was described and cultured by
Alexandre Yersin (Bacteriologist) in Hong Kong in 1894,
After which transmission of bacteria from rodents by flea bites was
discovered by Jean-Paul Simond in 1898.
History
1):-Plague of Justinian(541 to 750AD)
•spreading from Egypt to the Mediterranean (starting with the Plague of
Justinian) and northwestern Europe.
2):- The black death(1346 to 1353)
The Black Death was a bubonic plague pandemic occurring in Western
Eurasia and North Africa from 1346 to 1353. It is the most fatal pandemic
recorded in human history, causing the deaths of 75–200 million people,
peaking in Europe
Classification of plague
1)-Bubonic plague: The incubation period :- 2 to 8 days.
2)-Septicemic plague: incubation period of septicemic plague is
poorly defined but likely occurs within days of exposure. …
3)-Pneumonic plague: The incubation period :- 1 to 3 days.
Cycle of infection by yersinia pestis
Bubonic Plague
Bubonic plague is the most common form of plague and is caused by the bite
of an infected flea. Plague bacillus, Y. pestis, enters at the bite and travels
through the lymphatic system to the nearest lymph node where it replicates
itself
The lymph node then becomes inflamed, tense and painful, and is called a
‘bubo’. At advanced stages of the infection the inflamed lymph nodes can turn
into open sores filled with pus.
Human to human transmission of bubonic plague is rare.
Bubonic plague can advance and spread to the lungs, which is the more severe
type of plague called pneumonic plague.
Case-fatality ratio of 30% to 100% if left untreated.
Symptoms of bubonic plague
a). Malaise for 1-2 days
b). Onset is abrupt with fever 103°-104°F
c). Chills, headache
d. Face is congested
E). Painful lymphadenitis, and lymph nodes which become enlarged and tender
called buboes develop in the groins or axilla or neck. Buboes appear on 2 nd or 3rd
day.
G). Suppuration of buboes occurs. Buboes burst and
release foul smelling pus. They heal by fibrosis.
Septicemic plague
Septicemic plague is a systemic disease involving infection of the
blood
Septicemic plague can cause disseminated intravascular coagulation
and is always fatal when untreated
The septicemic plague was the least common
Septicemic plague can cause gangrene, which destroys your tissues.
Your fingers, hands, toes, feet or other body parts might turn black.
Prognosis of septicemic plague
Untreated septicemic plague is almost always fatal. Early treatment
with antibiotics reduces the mortality.
Death is almost inevitable if treatment is delayed more than about
24 hours, and some people may even die on the same day they
present with the disease.
Symptoms of septicemic plague
Bubonic plague may develop Into septicemic plague. It is characterized by:
a. High fever
b. Pallor - pale colouring of the skin
c. Prostration - a state of extreme physical exhaustion, weakness or collapse
D. Hemorrhages in the internal organs.
Pneumonic plague
Pneumonic plague, or lung-based plague, is the most virulent form of
plague.
Incubation can be as short as 24 hours.
Any person with pneumonic plague may transmit the disease via droplets
to other humans.
Untreated pneumonic plague, if not diagnosed and treated early, can be
fatal.
However, recovery rates are high if detected and treated in time (within
24 hours of onset of symptoms).
Sign and symptoms of pneumonic plague
a. Onset is abrupt with fever 103°-104°F.
b. Cough, dyspnea with blood stained sputum.
Mode of transmission
1):-Biological transmission: By the bite of infected rat flea.
2)-Contact with contaminated fluid or tissue
3):-Droplet infection: Pneumonic plague is highly infectious and is
spread directly from cases of pneumonic plague to persons through
droplet infection.
Epidemiology
Host factor
1)-Age and sex: All ages and both sexes are susceptible.No age and sex bar exists for
this disease.
2)- Human activities: Outdoor activities like hunting,grazing, cultivation, harvesting,
construction activities expose the man to come in contact with natural foci and flea-
man contact.
3. Movement of people: Movement of people and cargo by sea or land is associated
with plague, because rats and rat fleas are transported in this way
4. Immunity: Man has no natural immunity. Acquired
immunity after recovery lasts for a short period.
Recent trajectory of plague
Diagnosis
1. Staining the bubo fluid or blood with Giemsa’s or Wayson’s stain after fixing with
alcohol look for bipolar bacilli.
2. Culture: Blood or bubo fluid or sputum can be cultured to isolate the plague bacilli.
3. Serology: This is done for antibody titer.
Treatment
One of the following antibiotics may be used:
Streptomycin
Gentamicin
Tetracycline or Doxycycline
Chloramphenicol
Ciprofloxacin
17th century Plague doctor costume
Prevention and Control Measures
1)-Control of fleas:
•During epidemics, destruction of fleas is very important to break the . chain of transmission
rodents → flea → man.
2. Rodent control:
Rodent control using trapping, fumigation of rat burrows, good food storage facilities and
improvement of general sanitation should be undertaken.
3. Vaccination:
The WHO recommends vaccination against plague only for its prevention not for control of
human plague. It is a formaline killed plague vaccine which is in suspension form.
•Two doses of 0.5 and 1.0 ml subcutaneously for adults
•Booster doses are recommended every 6 months
4. Chemoprophylaxis:
• drug of choice is streptomycin (15 mg/kg, up to 1 g intramuscularly every 12 h) .
• alternative drug is sulfonamide 2-3 g daily for 5-7 days.
5. Surveillance:
6.Health education: Public should be educated about the following:
a. Facts about the disease, its mode of spread.
B. Signs and Symptoms.
C. Prompt reporting of dead rats and suspected human cases.
D. Personal protection measures to protect from flea bites, use of flea repellants, control of rodents, food
storage in covered containers and to maintain general sanitation in and around the house.
Control Measures
1.Early diagnosis and treatment: A large number of people suffering from fever and
enlarged lymphnodescan help in early diagnosis of plague.
2. Notification: All cases of human or rodents should be notified to health authorities as per
International Health Regulations in order to initiate control measures.
3. Isolation: All patients with pneumonic plague including suspected cases (and other
bubonic cases also if possible) should be isolated for 5 days of chemotherapy.
4. Treatment: Treatment should be started promptly on the basis of clinical (community)
diagnosis otherwise plague may have 50% mortality and pneumonic plague 100%. The drug
of choice is streptomycin.Alternate drug is tetracycline. Sulphonamides and gentamycin may
be given if other drugs are not available.
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