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by Randall B

Plague

(Pneumonic Plague; Bubonic Plague; Septicemic Plague; Pharyngeal Plague)

Definition

Plague is an infectious disease with an infamous past that has affected human history. Because of its contagious nature, plague is a weapon of bioterrorism. Although it is not as common as it once was, outbreaks of plague do occur today.
Types of plague include:
  • Pneumonic—in the lungs, from breathing in droplets or as a progression of another type
  • Bubonic—in the lymph nodes, occurring after a flea bite
  • Septicemic—a body system-wide infection, occurring after a flea bite
Plague is treated with isolation and antibiotics.

Causes

Plague is caused by specific bacteria.
Bubonic and septicemic plagues are spread by bites from infected fleas. Transmission can also occur when a person comes in contact with infected tissue or bodily fluids from another person or animal.
Pneumonic plague is spread by droplets in the air when an infected person coughs or sneezes. The disease is transmitted to another person when the droplets are inhaled. Transmission by droplets is the only way pneumonic plague spreads among people.
Pneumonic Plague Transmission
Droplets from an infected person are inhaled into the lungs.
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Risk Factors

Factors that may increase your chance of getting plague include:
  • Exposure to the bacteria
  • Contact with fleas or infected rodents
  • Living in the Southwest United States
You can get more information about the distribution of plague from the Centers for Disease Control and Prevention (CDC).

Symptoms

Pneumonic plague may cause:
  • Fever
  • Weakness
  • Headache
  • Cough
  • Bloody or watery mucous
  • Difficulty breathing
  • Chest pain
Bubonic plague may cause:
  • Fever
  • Chills
  • Weakness
  • Headache
  • Swollen, tender lymph nodes
  • Skin may appear red and tight over affected lymph nodes
Septicemic plague may cause:
  • Bleeding under the skin
  • Black fingers, toes, or nose
  • Fever
  • Chills
  • Weakness
Complications of plague include shock, organ failure, and death.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may ask about the possible source of exposure.
Test may include:
  • Blood tests to look for indications of an infection
  • Blood test to detect antibodies to plague bacteria
  • Examining body fluids using special techniques
  • Culture of body fluids to check for bacteria
  • Chest x-ray to look for signs of infection in the lungs

Treatment

Starting antibiotics early is essential. Any delay greatly increases the risk of death. The drugs are injected in a muscle or given through a vein. Later in treatment, some drugs can be given by mouth. A person with lung symptoms will be placed in isolation to protect others. Caregivers and visitors should wear a mask, gloves, goggles, and a gown. Cases are reported to public health officials.

Supportive Care for Septicemic Plague

Health professionals will monitor those with septicemic plague for changes in status and take appropriate action. Maintaining adequate heart function, blood pressure, and oxygen supply are of prime importance.

Prevention

Antibiotics may prevent infection following close contact with someone who has the disease. The drugs should be taken daily while in contact, and for seven days after the last exposure. In addition, the caregiver and person with plague should wear masks.
In the event of a terrorism exposure, antibiotics may be given to people in the affected areas who have a fever or cough. A vaccine does not exist for pneumonic plague.
Measures to prevent naturally occurring plague include:
  • Reduce or control rodent population near your home
  • Wear gloves when handling or skinning animals to protect contact with your skin
  • Use insect repellent containing DEET when you are outside
  • Keep fleas off your pets by using flea control products
  • Keep dogs and cats from sleeping in your bed if they roam in endemic areas

RESOURCES

Centers for Disease Control and Prevention http://www.cdc.gov

Johns Hopkins' Office of Critical Event Preparedness and Response (CEPAR) http://www.hopkins-cepar.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Public Health Agency of Canada http://www.phac-aspc.gc.ca

References

Consensus statement, plague as a biological weapon: Medical and public health management. JAMA. 2000;283(17):2281-2290.

Plague. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/plague. Updated November 28, 2012. Accessed May 24, 2013.

Plague. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 1, 2013. Accessed May 24, 2013.

Revision Information

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