Plague

Overview

Plague is a serious illness caused by a bacteria called Yersinia pestis. It mostly affects rodents and their fleas in rural and semirural areas, but can also occur in cities with poor sanitation or large rat populations. People working outdoors in areas with plague-carrying animals or people working in animal clinics in these regions have a risk of contact with the disease. Plague can be transmitted to humans through flea bites or direct contact with infected animals. There are three types of plague: bubonic, septicemic, and pneumonic. Bubonic plague causes swelling of lymph nodes, while septicemic plague affects the bloodstream, and pneumonic plague affects the lungs. If left untreated, plague can be deadly, but it can be treated with antibiotics.

Understanding the disease

Symptoms

The symptoms of plague can vary depending on the type of plague. There are three types of plague: bubonic plague, septicemic plague, and pneumonic plague. Bubonic plague causes swelling of lymph nodes (buboes) in the armpits, groin, or neck. Other symptoms may include a sudden high fever and chills, headache, tiredness, weakness, muscle aches, and occasionally skin sores. Septicemic plague occurs when plague bacteria multiply in the bloodstream, and buboes may not be present. Early symptoms include a sudden high fever and chills, extreme weakness, stomach pain, diarrhea, and vomiting. Advanced symptoms can include bleeding, shock, and gangrene. Pneumonic plague affects the lungs and may cause sudden high fever and chills, cough with bloody mucus, difficulty or irregular breathing, chest pain, upset stomach, vomiting, headache, and weakness. It can progress rapidly and be fatal if not treated within the first day. It is important to seek immediate medical care if you have a sudden high fever and live in an area with cases of plague.

Risk Factors

Risk factors for developing plague include:

1. Living or working in areas where plague-carrying animals are common, such as rural or semirural regions of western states like Arizona, California, Colorado, and New Mexico.
2. Engaging in outdoor activities like camping, hunting, or hiking in areas where these animals reside, increasing the risk of being bitten by an infected flea.
3. Working in animal clinics or having contact with pet cats and dogs in regions where plague is prevalent.
4. Direct contact with sick animals or their tissues, such as handling or skinning an animal with the illness. Plague is considered a potential bioweapon, and there is evidence of its use or development as a weapon in the past. The U.S. government has guidelines for treatment and prevention of plague used as a weapon. Remember that plague is a rare disease, and most cases occur in specific geographic areas and among people with certain occupational or recreational risk factors.

Development

The various types of plague develop differently:

1. Bubonic plague: This type of plague is characterized by the swelling of lymph nodes (buboes). It is caused by a bacterium called Yersinia pestis and is transmitted to humans through the bite of infected fleas that have been feeding on small rodents or their reservoir hosts, such as rats, mice, voles, squirrels, rabbits, prairie dogs, and ground squirrels.
2. Septicemic plague: This type of plague is a severe infection of the bloodstream. It can develop from untreated bubonic plague or from exposure to pneumonic plague. Symptoms include fever, chills, severe weakness, and rapid breathing.
3. Pneumonic plague: This type of plague affects the lungs and can be transmitted through the air when an infected person coughs or sneezes. It can also develop from untreated bubonic or septicemic plague. Symptoms include fever, chest pain, cough, and difficulty breathing. In summary, bubonic plague is caused by flea bites, septicemic plague can develop from untreated bubonic plague or exposure to pneumonic plague, and pneumonic plague is transmitted through the air.

Assessment and Diagnosis

Triage

You should see a doctor immediately if plague is suspected. This is particularly important if you have a sudden high fever, as well as other symptoms, especially if you live in an area that has had cases of plague. The western United States, including Arizona, California, Colorado, and New Mexico, have seen the majority of cases in the country. Plague is a serious illness that can progress rapidly and be deadly if not treated promptly with antibiotics. Therefore, it is crucial to seek immediate medical care if you suspect plague.

Diagnosis

To diagnose plague, a health care provider will likely take the following steps:

1. Assess symptoms: The health care provider will evaluate the patient's symptoms, including sudden onset of fever, headache, chills, muscle pain, and swollen lymph nodes (buboes).
2. Review recent activities: The provider will inquire about any recent outdoor activities, travel to areas where plague is common, contact with dead or sick animals, or known exposure to rodents.
3. Order laboratory tests: The provider may order blood tests, fluid samples from buboes, mucous from the lungs, or fluid surrounding the brain and spinal cord to identify the presence of Yersinia pestis bacteria.
4. Confirm diagnosis: Based on the patient's symptoms, exposure history, and laboratory test results, the health care provider will make a probable diagnosis of plague. It is important to note that plague is a serious and potentially life-threatening condition, so prompt medical attention and proper diagnosis are crucial. If plague is suspected, the patient should be treated with antibiotics as soon as possible, even before the test results are available.

Management and Treatment

Complications

Potential complications of plague include gangrene, meningitis, pharyngeal plague, and death. Gangrene occurs when blood clots form in the tiny blood vessels, causing tissue death. Meningitis is a rare condition caused by plague that affects the protective tissues surrounding the brain and spinal cord. Pharyngeal plague is present in the tissues behind the nasal cavity and mouth. Death risk is around 11% and is more likely with septicemic and pneumonic plague if not treated promptly.

Prevention

Pneumonic plague can be prevented through early treatment with antibiotics if a person was likely exposed to the disease. There is no available vaccine, but scientists are working on developing one. To reduce the risk of exposure, rodent-proofing your home and removing nesting areas for rodents is recommended. Pets' food should not be left in accessible areas for rodents. If you live or spend time outdoors in areas where plague occurs, such as the western United States, you can take precautions to avoid being bitten by infected fleas. While there are no specific hobbies that directly increase the risk of getting plague, camping, hunting, or hiking in areas where plague-carrying animals reside might increase the risk of being bitten by an infected flea.

Home Remedies

There are no specific home remedies suggested for plague, as it is a serious and potentially life-threatening illness that requires prompt medical attention. Antibiotics are the primary treatment for plague, and they should be administered as soon as possible to reduce the risk of complications and potential death. It is essential to seek medical care immediately if you suspect you have been exposed to plague or are experiencing symptoms such as fever, chills, headache, swollen lymph nodes, cough, or difficulty breathing. Remember, plague is a rare disease, and the best way to prevent it is by reducing your risk of exposure. This includes rodent-proofing your home, protecting your pets, using insect repellents when outdoors, and avoiding areas where plague-carrying animals are common.

Treatment

Plague is usually treatable with antibiotics. If left untreated, it can be deadly. Antibiotics effective against the bacteria causing plague include streptomycin, gentamicin, doxycycline, and ciprofloxacin. Treatment should begin as soon as possible after suspected exposure to plague to minimize the risk of severe complications, including death. In the case of pneumonic plague, treatment must begin within 24 hours of symptom onset for the best chance of recovery.

Preparing for medical consultation

To prepare for an appointment for plague, you should:

1. Report any relevant travel or possible exposure to rodents or dead animals.
2. Write down any symptoms, including when they started.
3. Make a list of all medications, vitamins, and supplements.
4. Write down questions to ask the healthcare provider.
5. Be aware of any pre-appointment restrictions.
6. Note any symptoms, including changes in mood, thinking, or behavior.
7. Mention any recent moves, vacations, or interactions with animals.
8. List all medicines, vitamins, or supplements you're taking.
9. Consider bringing a family member or friend to the appointment for support.
10. Bring previous scans or X-rays and any other relevant medical records to the appointment.