$Unique_ID{BRK03546} $Pretitle{} $Title{Bubonic Plague} $Subject{Bubonic Plague Pestis Pestis Fulminans Pestis Major Black Death Black Plague Glandular Plague Hemorrhagic Plague Plague Pestis Minor Typhoid Fever Primary Pneumonic Plague Septicemic Plague} $Volume{} $Log{} Copyright (C) 1987, 1988, 1989 National Organization for Rare Disorders, Inc. 428: Bubonic Plague ** IMPORTANT ** It is possible the main title of the article (Bubonic Plague) is not the name you expected. Please check the SYNONYMS listing on the next page to find alternate names, disorder subdivisions, and related disorders covered by this article. Synonyms Pestis Pestis Fulminans Pestis Major Black Death Black Plague Glandular Plague Hemorrhagic Plague Plague DISORDER SUBDIVISIONS Pestis Minor Information on the following diseases can be found in the Related Disorders section of this report: Typhoid Fever Primary Pneumonic Plague Septicemic Plague General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Bubonic Plague is an acute, severe infectious disorder caused by the bacteria (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 severe complications or death. A milder form of Bubonic Plague, Pestis Minor, usually resolves in approximately a week with appropriate treatment. Symptoms 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). The patient may become restless, confused, delirious and/or uncoordinated. 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. Causes 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 transmit the bacteria to other animals or humans. Direct contact with infected animal tissues can also spread this disorder. Additionally, a cough can spread the infection between humans after development of lesions in the lungs. Affected Population 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. Related Disorders 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. Therapies: Standard 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 (although some bacteria strains may be resistant to this drug). Travelers to countries where the risk of contracting Bubonic Plague is high, such as southeast Asia or southern Africa should be immunized. Therapies: Investigational This disease entry is based upon medical information available through September 1989. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Bubonic Plague, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Institute of Allergy and Infections Diseases (NIAID) 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 Centers for Disease Control (CDC) 1600 Clifton Road, NE Atlanta, GA 30333 (404) 639-3534 References PLAGUE: The Harvard Medical School Newsletter (June 1987, Vol. 12, No. 8). Pp. 3-4. HUMAN BUBONIC PLAGUE TRANSMITTED BY A DOMESTIC CAT SCRATCH: B.G. Weniger, et al.; JAMA (February 17, 1984, issue 251(7)). Pp. 927-928. EPIDEMIOLOGIC AND CLINICAL FEATURES OF AN OUTBREAK OF BUBONIC PLAGUE IN NEW MEXICO: C.F. von Reyn, et al.; J Infect Dis (October 1977, issue 136(4)). Pp. 489-494. MULTIPLE LUNG CAVITIES IN A 12-YEAR-OLD GIRL WITH BUBONIC PLAGUE, SEPSIS, AND SECONDARY PNEUMONIA: A.L. Florman, et al.; Am J Med (June 1986, issue 80(6)). Pp. 1191-1193.