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$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.