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Plague

Bubonic plague; Pneumonic plague; Septicemic plague

 

Plague is a severe and potentially deadly bacterial infection.

Causes

 

Plague is caused by the bacteria Yersinia pestis. Rodents such as rats carry the disease. It is spread by their fleas.

People can get plague when they are bitten by a flea that carries the plague bacteria from an infected rodent. In rare cases, people get the disease when handling an infected animal.

Plague lung infection is called pneumonic plague. It can be spread from person to person. When someone with pneumonic plague coughs, tiny droplets carrying the bacteria move through the air. Anyone who breathes in these particles may catch the disease. An epidemic can be started this way.

In the Middle Ages in Europe, massive plague epidemics killed millions of people. Plague has not been eliminated. It can still be found in Africa, Asia, and South America.

Today, plague is rare in the United States. But it has been known to occur in parts of California, Arizona, Colorado, and New Mexico.

The three most common forms of plague are:

  • Bubonic plague, an infection of the lymph nodes
  • Pneumonic plague, an infection of the lungs
  • Septicemic plague, an infection of the blood

The time between being infected and developing symptoms is typically 2 to 8 days. But the time can be as short as 1 day for pneumonic plague.

Risk factors for plague include a recent flea bite and exposure to rodents, especially rabbits, squirrels, or prairie dogs, or scratches or bites from infected domestic cats.

 

Symptoms

 

Bubonic plague symptoms appear suddenly, usually 2 to 5 days after exposure to the bacteria. Symptoms include:

  • Fever and chills
  • General ill feeling (malaise)
  • Headache
  • Muscle pain
  • Seizures
  • Smooth, painful lymph gland swelling called a bubo that is commonly found in the groin, but may occur in the armpits or neck, most often at the site of the infection (bite or scratch); pain may start before the swelling appears

Pneumonic plague symptoms appear suddenly, typically 2 to 3 days after exposure. They include:

  • Severe cough
  • Difficulty breathing and pain in the chest when breathing deeply
  • Fever
  • Frothy, bloody sputum

Septicemic plague may cause death even before symptoms occur. Symptoms can include:

  • Abdominal pain
  • Bleeding due to blood clotting problems
  • Diarrhea
  • Fever
  • Nausea
  • Vomiting

 

Exams and Tests

 

Tests that may be done include:

  • Blood culture
  • Culture of lymph node aspirate (fluid taken from an affected lymph node or bubo)
  • Sputum culture

 

Treatment

 

People with the plague need immediate treatment. If treatment is not received within 24 hours of when the first symptoms occur, death can result.

Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague. Oxygen, intravenous fluids, and respiratory support are usually also needed.

People with pneumonic plague must be isolated from caregivers and other patients. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

 

Outlook (Prognosis)

 

Without treatment, about 50% of persons with bubonic plague die. Almost everyone with pneumonic plague dies if not treated. Treatment reduces the death rate to 50%.

 

When to Contact a Medical Professional

 

Call your health care provider if you develop plague symptoms after exposure to fleas or rodents, especially if you live in or have visited an area where plague occurs.

 

Prevention

 

Rat control and watching for the disease in the wild rodent population are the main measures used to control the risk of epidemics. The plague vaccine is no longer used in the U.S. New vaccines are being developed.

 

 

References

Mead PS. Yersinia species (including plague). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 231.

Shandro JR, Jenkins JG. Wilderness-acquired zoonoses. In: Auerbach PS. Wilderness Medicine. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 59.

 
  • Flea

    Flea - illustration

    Different types of fleas prefer specific animals as hosts, but will infest humans if their specific hosts are unavailable. Fleas can carry plague and typhus. They are also thought to transmit several other diseases. (Image courtesy of the Centers for Disease Control and Prevention.)

    Flea

    illustration

  • Flea bite - close-up

    Flea bite - close-up - illustration

    Fleas are blood-feeding insects. Pain and itching results from an allergic reaction to the materials that the fleas inject into the skin at the time of the bite.

    Flea bite - close-up

    illustration

  • Antibodies

    Antibodies - illustration

    Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

    Antibodies

    illustration

    • Flea

      Flea - illustration

      Different types of fleas prefer specific animals as hosts, but will infest humans if their specific hosts are unavailable. Fleas can carry plague and typhus. They are also thought to transmit several other diseases. (Image courtesy of the Centers for Disease Control and Prevention.)

      Flea

      illustration

    • Flea bite - close-up

      Flea bite - close-up - illustration

      Fleas are blood-feeding insects. Pain and itching results from an allergic reaction to the materials that the fleas inject into the skin at the time of the bite.

      Flea bite - close-up

      illustration

    • Antibodies

      Antibodies - illustration

      Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

      Antibodies

      illustration


     

    Review Date: 5/1/2015

    Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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