Plague

Definition

Plague is a serious, potentially life-threatening infectious disease that is usually transmitted to humans by the bites of rodent fleas. It was one of the scourges of early human history. There are three major forms of the disease: bubonic, septicemic, and pneumonic.

Description

Plague has been responsible for three great world pandemics, which caused millions of deaths and significantly altered the course of history. A pandemic is a disease occurring in epidemic form throughout the entire population of a country, a people, or the world. Although the cause of the plague was not identified until the third pandemic in 1894, scientists are virtually certain that the first two pandemics were plague because a number of the survivors wrote about their experiences and described the symptoms.

The first great pandemic appeared in AD 542 and lasted for 60 years. It killed millions of citizens, particularly people living along the Mediterranean Sea. This sea was the busiest, coastal trade route at that time and connected what is now southern Europe, northern Africa, and parts of coastal Asia. This pandemic is sometimes referred to as the Plague of Justinian, named for the great emperor of Byzantium who was ruling at the beginning of the outbreak. According to the historian Procopius, this outbreak of plague killed 10,000 people per day at its height just within the city of Constantinople.

The second pandemic occurred during the fourteenth century, and was called the Black Death because its main symptom was the appearance of black patches (caused by bleeding) on the skin. It was also a subject found in many European paintings, drawings, plays, and writings of that time. The connections between large active trading ports, rats coming off the ships, and the severe outbreaks of the plague were understood by people at the time. This was the most severe of the three, beginning in the mid-1300s with an origin in central Asia and lasting for 400 years. Between a fourth and a third of the entire European population died within a few years after plague was first introduced. Some smaller villages and towns were completely wiped out.

The final pandemic began in northern China, reaching Canton and Hong Kong by 1894. From there, it spread to all continents, killing millions.

The great pandemics of the past occurred when wild rodents spread the disease to rats in cities, and then to humans when the rats died. Another route for infection came from rats coming off ships that had traveled from heavily infected areas. Generally, these were busy coastal or inland trade routes. Plague was introduced into the United States during this pandemic and it spread from the West towards the Midwest and became endemic in the Southwest of the United States.

About 10-15 Americans living in the southwestern United States contract plague each year during the spring and summer. The last rat-borne epidemic in the United States occurred in Los Angeles in 1924–25. Since then, all plague cases in this country have been sporadic, acquired from wild rodents or their fleas. Plague can also be acquired from ground squirrels and prairie dogs in parts of Arizona, New Mexico, California, Colorado, and Nevada. Around the world, there are between 1,000 and 2,000 cases of plague each year. Recent outbreaks in humans occurred in Africa, South America, and Southeast Asia.

Some people and/or animals with bubonic plague go on to develop pneumonia (pneumonic plague). This can spread to others via infected droplets during coughing or sneezing.

Plague is one of three diseases still subject to international health regulations. These rules require that all confirmed cases be reported to the World Health Organization (WHO) within 24 hours of diagnosis. According to the regulations, passengers on an international voyage who have been to an area where there is an epidemic of pneumonic plague must be placed in isolation for six days before being allowed to leave.

While plague is found in several countries, there is little risk to United States travelers within endemic areas (limited locales where a disease is known to be present) if they restrict their travel to urban areas with modern hotel accommodations.

Over the past few years, this infection primarily of antiquity has become a modern issue. This change has occurred because of the concerns about the use of plague as a weapon of biological warfare or terrorism (bioterrorism). Along with anthrax and smallpox, plague is considered to be a significant risk. In this scenario, the primary manifestation is likely to be pneumonic plague transmitted by clandestine aerosols. It has been reported that during World War II the Japanese dropped "bombs" containing plague-infected fleas in China as a form of biowarfare.

Causes and symptoms

Fleas carry the bacterium Yersinia pestis, formerly known as Pasteurella pestis. The plague bacillus can be stained with Giemsa stain and typically looks like a safety pin under the microscope. When a flea bites an infected rodent, it swallows the plague bacteria. The bacteria are passed on when the fleas, in turn, bite a human. Interestingly, the plague bacterium grows in the gullet of the flea, obstructing it and not allowing the flea to eat. Transmission occurs during abortive feeding with regurgitation of bacteria into the feeding site. Humans also may become infected if they have a break or cut in the skin and come in direct contact with body fluids or tissues of infected animals.

More than 100 species of fleas have been reported to be naturally infected with plague; in the western United States, the most common source of plague is the golden-manteled ground squirrel flea. Chipmunks and prairie dogs have also been identified as hosts of infected fleas.

Since 1924, there have been no documented cases in the United States of human-to-human spread of plague from droplets. All but one of the few pneumonic cases have been associated with handling infected cats. While dogs and cats can become infected, dogs rarely show signs of illness and are not believed to spread disease to humans. However, plague has been spread from infected coyotes (wild dogs) to humans. In parts of central Asia, gerbils have been identified as the source of cases of bubonic plague in humans.

Bubonic plague

Two to five days after infection, patients experience a sudden fever, chills, seizures, and severe headaches, followed by the appearance of swellings or "buboes" in armpits, groin, and neck. The most commonly affected sites are the lymph glands near the site of the first infection. As the bacteria multiply in the glands, the lymph node becomes swollen. As the nodes collect fluid, they become extremely tender. Occasionally, the bacteria will cause an ulcer at the point of the first infection.

Septicemic plague

Bacteria that invade the bloodstream directly (without involving the lymph nodes) cause septicemic plague. (Bubonic plague also can progress to septicemic plague if not treated appropriately.) Septicemic plague that does not involve the lymph glands is particularly dangerous because it can be hard to diagnose the disease. The bacteria usually spread to other sites, including the liver, kidneys, spleen, lungs, and sometimes the eyes, or the lining of the brain. Symptoms include fever, chills, prostration, abdominal pain, shock, and bleeding into the skin and organs.

Pneumonic plague

Pneumonic plague may occur as a direct infection (primary) or as a result of untreated bubonic or septicemic plague (secondary). Primary pneumonic plague is caused by inhaling infective drops from another person or animal with pneumonic plague. Symptoms, which appear within one to three days after infection, include a severe, overwhelming pneumonia, with shortness of breath, high fever, and blood in the phlegm. If untreated, half the patients will die; if blood poisoning occurs as an early complication, patients may die even before the buboes appear.

Life-threatening complications of plague include shock, high fever, problems with blood clotting, and convulsions.

Diagnosis

Plague should be suspected if there are painful buboes, fever, exhaustion, and a history of possible exposure to rodents, rabbits, or fleas in the West or Southwest. The patient should be isolated. Chest x rays are taken, as well as blood cultures, antigen testing, and examination of lymph node specimens. Blood cultures should be taken 30 minutes apart, before treatment.

A group of German researchers reported in 2004 on a standardized enzyme-linked immunosorbent assay (ELISA) kit for the rapid diagnosis of plague. The test kit was developed by the German military and has a high degree of accuracy as well as speed in identifying the plague bacillus. The kit could be useful in the event of a bioterrorist attack as well as in countries without advanced microbiology laboratories.

Treatment

As soon as plague is suspected, the patient should be isolated, and local and state departments notified. Drug treatment reduces the risk of death to less than 5%. The preferred treatment is streptomycin administered as soon as possible. Alternatives include gentamicin, chloramphenicol, tetracycline, or trimethoprim/sulfamethoxazole.

Prognosis

Plague can be treated successfully if it is caught early; the mortality rate for treated disease is 1-15% but 40-60% in untreated cases. Untreated pneumonic plague is almost always fatal, however, and the chances of survival are very low unless specific antibiotic treatment is started within 15-18 hours after symptoms appear. The presence of plague bacteria in a blood smear is a grave sign and indicates septicemic plague. Septicemic plague has a mortality rate of 40% in treated cases and 100% in untreated cases.

Prevention

Anyone who has come in contact with a plague pneumonia victim should be given antibiotics, since untreated pneumonic plague patients can pass on their illness to close contacts throughout the course of the illness. All plague patients should be isolated for 48 hours after antibiotic treatment begins. Pneumonic plague patients should be completely isolated until sputum cultures show no sign of infection.

Residents of areas where plague is found should keep rodents out of their homes. Anyone working in a rodent-infested area should wear insect repellent on skin and clothing. Pets can be treated with insecticidal dust and kept indoors. Handling sick or dead animals (especially rodents and cats) should be avoided.

Plague vaccines have been used with varying effectiveness since the late nineteenth century. Experts believe that vaccination lowers the chance of infection and the severity of the disease. However, the effectiveness of the vaccine against pneumonic plague is not clearly known.

Vaccinations against plague are not required to enter any country. Because immunization requires multiple doses over a 6-10 month period, plague vaccine is not recommended for quick protection during outbreaks. Moreover, its unpleasant side effects make it a poor choice unless there is a substantial long-term risk of infection. The safety of the vaccine for those under age 18 has not been established. Pregnant women should not be vaccinated unless the need for protection is greater than the risk to the unborn child. Even those who receive the vaccine may not be completely protected. The inadequacy of the vaccines available as of the early 2000s explains why it is important to protect against rodents, fleas, and people with plague. A team of researchers in the United Kingdom reported in the summer of 2004 that an injected subunit vaccine is likely to offer the best protection against both bubonic and pneumonic forms of plague.

KEY TERMS

Bioterrorism— The use of disease agents to terrorize or intimidate a civilian population.

Buboes— Smooth, oval, reddened, and very painful swellings in the armpits, groin, or neck that occur as a result of infection with the plague.

Endemic— A disease that occurs naturally in a geographic area or population group.

Epidemic— A disease that occurs throughout part of the population of a country.

Pandemic— A disease that occurs throughout a regional group, the population of a country, or the world.

Septicemia— The medical term for blood poisoning, in which bacteria have invaded the bloodstream and circulates throughout the body.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Plague (Bubonic Plague; Pestis; Black Death)." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Davis, S., M. Begon, L. DeBruyn, et al. "Predictive Thresholds for Plague in Kazakhstan." Science 304 (April 30, 2004): 736-738.

Gani, R., and S. Leach. "Epidemiologic Determinants for Modeling Pneumonic Plague Outbreaks." Emerging Infectious Diseases 10 (April 2004): 608-614.

Splettstoesser, W. D., L. Rahalison, R. Grunow, et al. "Evaluation of a Standardized F1 Capsular Antigen Capture ELISA Test Kit for the Rapid Diagnosis of Plague." FEMS Immunology and Medical Microbiology 41 (June 1, 2004): 149-155.

Titball, R. W., and E. D. Williamson. "Yersinia pestis (Plague) Vaccines." Expert Opinion on Biological Therapy 4 (June 2004): 965-973.

Velendzas, Demetres, MD, and Susan Dufel, MD. "Plague." eMedicine December 2, 2004. 〈http://www.emedicine.com/EMERG/topic428.htm〉.

ORGANIZATIONS

Centers for Disease Control. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. 〈http://www.cdc.gov〉.

National Institute of Allergies and Infectious Diseases, Division of Microbiology and Infectious Diseases. Bldg. 31, Rm. 7A-50, 31 Center Drive MSC 2520, Bethesda, MD 20892.

World Health Organization. Division of Emerging and Other Communicable Diseases Surveillance and Control. 1211 Geneva 27, Switzerland.

OTHER

Bacterial Diseases (Healthtouch). 〈http://www.healthtouch.com/level1/leaflets/105825/105826.htm〉.

Bug Bytes. 〈http://www.isumc.edu/bugbytes/〉.

Centers for Disease Control. 〈http://www.cdc.gov/travel/travel.html〉.

Infectious Diseases Weblink. 〈http://pages.prodigy.net/pdeziel/〉.

International Society of Travel Medicine. 〈http://www.istm.org〉.

World Health Organization. 〈http://www.who.ch/〉.

plague

The generic term plague covers a host of epidemic diseases, with the most familiar being a rapidly spreading, often-fatal infection caused by Yersinia pestis. The Yersinia pestis bacillus causes a variety of symptoms, with the most common being a painful swelling of the lymph nodes that causes an abnormal growth known as a bubo in the groin or under the armpits (from “bubo” comes the term “bubonic plague”). In the Middle Ages, the bacillus was spread by a flea hosted by rats, the common companions of peasants as well as city-dwellers. The plague spread rapidly, sometimes killing as much as 80 percent of the local population, leaving entire regions depopulated, and causing a breakdown of civil order. The plague outbreak of 1347–1349, also known as the Black Death, was the worst in history and reduced the population of Europe by about one-third. Mortality was especially high among the aged, but a second wave in the 1360s, known as the “children's plague,” had a higher mortality rate among the young. The population of the continent fell dramatically in the fourteenth century, which was also a time of widespread famine and, in France, the devastating effects of the Hundred Years' War.

The plague played an important role in ending traditional medieval society. By eliminating so much of the labor force, the epidemic drove up wage rates. This gave serfs an opportunity to defy the manorial system, in which they were tied to the estates of the landowners, and become free-roaming peasants. Many peasants moved to the cities to take up artisanal trades in the cities.

The plague turned the social order upside down and inspired important works of art and literature. Plague played a central role in the Decameron of Giovanni Boccaccio, a collection of stories told by a group of young men and women who flee a plague-ridden town for the safety of the countryside. The plague also prompted new writings and historical tracts concerning the history and nature of contagious disease, a first step toward the modern understanding of disease and its causes.

Plague outbreaks continued during the Renaissance, striking cities seemingly at random. Cities were affected more than rural areas; some regions of Europe and cities were spared, while others were devastated. The plague continued to strike Europe at regular intervals through the Renaissance and did not subside until the early eighteenth century, when a final serious outbreak occurred in the French port of Marseille.

The plague forced cities to organize new methods of combating epidemics. Italy led the way during the early Renaissance in fighting plague through civic organizations. The disease prompted Florence and other cities to create civic organizations and committees responsible for new public health measures, such as the enforcement of sanitary laws, the prompt disposal of the dead, and the quarantining of plague-stricken houses. Special hospitals were set up to treat plague victims, and a new system of quarantining ships was set up in ports, which isolated crew, passengers, and cargo for a certain period (usually a month) in order to make sure the ship was not carrying any epidemics. Larger urban administrations became permanent, as cities placed authority in health officials drawn from the citizenry.

Most believed the plague to be the workings of God's wrath for the sins and corruption of humanity. In places where the plague struck, it was common for the citizens to hold public displays of repentance for their sins. At the same time, scientists and doctors were taking the first steps in understanding how the plague was transmitted. They examined victims and watched the progress of the disease, comparing cases and taking note of preventive measures that seemed to work. In this way, the plague helped medical science to progress to its modern era of diagnosis, treatment, and prevention.

See Also: Boccaccio, Giovanni; medicine

plague / plāg/ • n. a contagious bacterial disease characterized by fever and delirium, typically with the formation of buboes (see bubonic plague) and sometimes infection of the lungs ( pneumonic plague): an outbreak of plague they died of the plague. ∎  a contagious disease that spreads rapidly and kills many people. ∎  an unusually large number of insects or animals infesting a place and causing damage: a plague of fleas. ∎  [in sing.] a thing causing trouble or irritation: staff theft is usually the plague of restaurants. ∎  a widespread affliction regarded as divine punishment: the plagues of Egypt. ∎  [in sing.] archaic used as a curse or an expression of despair or disgust: a plague on all their houses! • v. (plagues , plagued , pla·guing ) [tr.] cause continual trouble or distress to: the problems that plagued the company he has been plagued by ill health. ∎  pester or harass (someone) continually: he was plaguing her with questions. ORIGIN: late Middle English: Latin plaga ‘stroke, wound,’ probably from Greek (Doric dialect) plaga, from a base meaning ‘strike.’

PLAGUE

Epidemic disease spread by fleas that infest rats.

Plague is caused by the bacillus Pasteurella pestis. Bubonic plague, which affects the lymph nodes, is most commonly identified with major epidemics since the fourteenth century; it can decrease infected populations by as much as one-third. Numerous outbreaks were recorded in the Middle East in the nineteenth century. The most severe bubonic plague epidemic in the twentieth century was in Egypt, some 520 miles south of Cairo, in 1912. Some 237 deaths out of a total of 357 cases were recorded.

Pneumonic plague, which affects the lungs, occurs more commonly during the winter; it is highly infectious, with a mortality rate of almost 100 percent. It is spread through the air from person to person. Septicemic plague, which affects the bloodstream, is the rarest form. It is 100 percent fatal, because death occurs within a few hours of infection.

jenab tutunji

plague in specific use, a contagious bacterial disease characterized by fever and delirium, typically with the formation of buboes (as bubonic plague; see also Great Plague). Recorded from late Middle English, the word comes from Latin plaga ‘stroke, wound’, probably from Greek (Doric dialect) plaga, from a base meaning ‘strike’.

St Roch and St Sebastian are traditionally invoked against plague.
a plague on all their houses! an animadversion echoing the words of the mortally wounded Mercutio in Shakespeare's Romeo and Juliet.
plague-pit a deep pit for the common burial of plague victims.
Plagues of Egypt the ten plagues, described in Exodus 7 to Exodus 12, visited on the Egyptians to persuade them to release the Israelites.

plague (playg) n.
1. any epidemic disease with a high death rate.

2. an acute epidemic disease of rats and other wild rodents caused by the bacterium Yersinia pestis, which is transmitted to humans by rat fleas. bubonic p. the most common form of the disease, characterized by acute painful swellings of the lymph nodes (see bubo). In favourable cases the buboes burst and then heal; in other cases bleeding under the skin can lead to ulcers, which may prove fatal. pneumonic p. a serious form of plague in which the lungs are affected. septicaemic p. a serious form of plague in which bacteria enter the bloodstream.

Plague

What Is Plague?

How Common Is Plague?

How Is Plague Spread?

What Are the Signs and Symptoms of Plague?

How Do Doctors Diagnose and Treat Plague?

How Can People Prevent Becoming Infected?

Resources

Plague (PLAYG) is a potentially serious bacterial infection that is spread to humans by infected rodents and their fleas.

KEYWORDS

for searching the Internet and other reference sources

Biological weapon

Bioterrorism

Black Death

Buboes

Bubonic plague

Pneumonic plague

Septicemic plague

Yersinia pestis

Zoonoses

What Is Plague?

Plague is a disease caused by the bacterium Yersinia pestis (yer-SIN-e-uh PES-tis). It has been in existence for at least 2,000 years and in the twenty-first century is still found in Africa, Asia, South America, and North America.

There are three types of plague. Pneumonic (nu-MOH-nik) involves the lungs; bubonic (byoo-BAH-nik), the most common form, involves the body’s lymphatic system*; and septicemic (sep-tih-SEE-mik) involves the bloodstream and spreads throughout the body. Septicemic plague can occur by itself or along with pneumonic or bubonic plague.

*lymphatic

(lim-FAH-tik) system is a system that contains lymph nodes and a network of channels that carry fluid and cells of the immune system through the body.

Bioweapons

Plague bacteria are considered to be one of several deadly organisms that could be used in biological warfare*. It is feared that the bacteria could be aerosolized (AIR-o-suh-lized), or processed into tiny particles that could be released into the air.

*biological warfare

is a method of waging war by using harmful microorganisms to purposely spread disease to many people.

A plague vaccine* was available to the general public but was discontinued by its manufacturers in 1999. Even if the vaccine were made available today, it would not be able to prevent the pneumonic form of plague, which is resistant to treatment as well.

*vaccine

(vak-SEEN) is a preparation of killed or weakened germs, or a part of a germ or product it produces, given to prevent or lessen the severity of the disease that can result if a person is exposed to the germ itself. Use of vaccines for this purpose is called immunization.

The plague has been used as a weapon before. In 1346 the Tartar army tried to capture the port city of Caffa on the Black Sea in the Crimea. The army catapulted bodies of plague victims over the city wall; an epidemic of plague ensued and the city surrendered.

Wild rats and fleas often are associated with plague, because they were the primary carriers of the disease during history’s most devastating outbreaks. Other types of rodents (and their fleas) can carry plague as well, such as prairie dogs, chipmunks, wood rats, and ground squirrels.

How Common Is Plague?

The World Health Organization reports 1,000 to 3,000 cases of plague worldwide annually. In the United States, 10 to 20 cases are reported every year, usually in rural areas in northern New Mexico, northern Arizona, southern Colorado, California, western Nevada, and southern Oregon. The last outbreak in the United States was in 1924–25 in Los Angeles. Plague has not been seen in Europe since World War II.

How Is Plague Spread?

Plague is transmitted in several ways. The most common is from animal to human through the bite of infected fleas. Fleas living on infected animals ingest the animals’ blood and the bacteria in it. They then spread the disease to other animals and humans through their bite, which can result in the bubonic or septicemic form of plague. Bacteria also can

The Black Death

The first pandemic (an outbreak of disease over a large geographical area, often worldwide) of plague chronicled by historians occurred between 542 and 546 A.D., during the Roman emperor Justinian’s reign. The plague followed trade routes to other countries, and the Roman army itself carried plague during war campaigns throughout Asia Minor, Western Europe, Italy, and Africa. Outbreaks continued for the next 300 years before the disease finally subsided.

An equally devastating second pandemic erupted nearly 800 years later, as plague once again traveled across trade routes and infected population pockets throughout Europe. Known as the Black Death, this fourteenth century outbreak killed more than one third of Europe’s population.

During these first two pandemics, the source of plague (rats and, more importantly, their infected fleas) was unknown. The spread of disease went unexplained, and many people feared it was a punishment sent by God.

enter the body through an open cut or wound after direct contact with infected people or animals.

In addition, humans and animals (such as cats) with plague can spread the disease by releasing tiny drops containing the bacteria from their mouth and nose; in humans, this happens when a person coughs, sneezes, or talks. As these drops enter the air, the smaller ones can float for up to 1 hour, whereas the larger drops settle on nearby objects. A sneeze or cough can send thousands of infected particles into the air. If inhaled, these drops can cause the pneumonic form of plague. This way of spreading the disease requires relatively close contact with an infected person or animal.

What Are the Signs and Symptoms of Plague?

Symptoms typically appear 2 to 6 days after infection. Sudden fever, chills, and headache, followed by swollen, painful, hot-to-the-touch lymph nodes*, known as buboes (BYOO-boze), are the hallmarks of bubonic plague. Lymph nodes in the groin are most commonly affected. If left untreated, the infection eventually spreads to the bloodstream, causing sepsis*, pneumonia*, or meningitis*.

*lymph

(LIMF) nodes are small, bean-shaped masses of tissue that contain immune system cells that fight harmful microorganisms. Lymph nodes may swell during infections.

*sepsis

is a potentially serious spreading of infection, usually bacterial, through the bloodstream and body.

*pneumonia

(nu-MO-nyah) is inflammation of the lung.

*meningitis

(meh-nin-JY-tis) is an inflammation of the meninges, the membranes that surround the brain and the spinal cord. Meningitis is most often caused by infection with a virus or a bacterium.

In septicemic plague, the bacteria multiply in the blood, causing symptoms such as fever, chills, weakness, abdominal* pain, nausea (NAW-zee-uh), and vomiting. As the infection progresses, the blood pressure drops and the blood is unable to clot* normally. The skin looks bruised from uncontrolled bleeding, which is why historically the disease was called the Black Death.

*abdominal

(ab-DAH-mih-nul) refers to the area of the body below the ribs and above the hips that contains the stomach, intestines, and other organs.

*clot

is the process by which the body forms a thickened mass of blood cells and protein to stop bleeding.

The pneumonic form of plague takes hold rapidly, with symptoms such as fever, cough, chills, chest pain, bloody sputum*, and headache. It can progress to respiratory failure* and shock* within 2 to 4 days.

*sputum

(SPYOO-tum) is a substance that contains mucus and other matter coughed out from the lungs, bronchi, and trachea.

*respiratory failure

is a condition in which breathing and oxygen delivery to the body is dangerously altered. This may result from infection, nerve or muscle damage, poisoning, or other causes.

*shock

is a serious condition in which blood pressure is very low and not enough blood flows to the body’s organs and tissues. Untreated, shock may result in death.

How Do Doctors Diagnose and Treat Plague?

Determining whether a person was in close contact with animals that can carry plague or has traveled to an area where the plague is known to occur can be key in making the diagnosis. Bubonic plague can be identified by the characteristic swollen lymph nodes. A blood culture* and a lymph node biopsy* may be done, as well as a culture of a sputum sample to look for Yersinia pestis bacteria.

*culture

(KUL-chur) is a test in which a sample of fluid or tissue from the body is placed in a dish containing material that supports the growth of certain organisms. Typically, within days the organisms will grow and can be identified.

*biopsy

(BI-op-see) is a test in which a small sample of skin or other body tissue is removed and examined for signs of disease.

Getting timely treatment for plague is critical. Without treatment, bubonic plague is fatal in 50 to 60 percent of cases. Septicemic plague and pneumonic plague are fatal in almost all cases if not treated within 24 to 48 hours.

Suspected plague patients are isolated and hospitalized, where they are treated with antibiotics, intravenous* (IV) fluids, and oxygen. Anyone who has come in close contact with someone diagnosed with plague is treated with antibiotics to prevent contracting the infection. All suspected cases of plague must be reported to state and local health departments. Treatment and full recovery from plague can take several weeks or longer. Complications of plague include damage to vital organs

*intravenous

(in-tra-VEE-nus) means within or through a vein. For example, medications, fluid, or other substances can be given through a needle or soft tube inserted through the skin’s surface directly into a vein.

due to lack of blood flow associated with sepsis, brain damage from lack of oxygen, lung damage, and death.

How Can People Prevent Becoming Infected?

Some people are at a higher risk for developing plague than others, such as lab technicians who handle the bacterium or blood samples taken from people who are infected, people who work in areas where plague occurs, and people who work with animals that carry the disease.

A person’s risk of developing plague can be lowered by limiting contact with wild animals that might carry the disease, removing potential food sources and shelter for rodents near the home, treating pet dogs and cats weekly for fleas, and using insecticides to kill fleas around the home during outbreaks of plague in wild animals. Rat management in rural and urban areas also can minimize the potential for disease.

Antibiotics sometimes are prescribed to prevent infection if a person has been exposed to plague.

See also

Bioterrorism

Pneumonia

Sepsis

Travel-related Infections

Zoonoses

Resources

Organization

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. The CDC is the U.S. government authority for information about infectious and other diseases, including plague.

Telephone 800-311-3435 http://www.cdc.gov

U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894. The National Library of Medicine has a website packed with information on diseases (such as plague) and drugs, consumer resources, dictionaries and encyclopedias of medical terms, and directories of doctors and helpful organizations.

Telephone 888-346-3656 http://www.nlm.nih.gov

World Health Organization (WHO), Avenue Appia 20, 1211 Geneva 27, Switzerland. WHO provides information about plague at its website.

Telephone 011-41-22-791-2111 http://www.who.int

plague Acute, infectious disease of humans and rodents caused by the bacillus Yersinia pestis. In humans, it occurs in three forms: bubonic plague, most common and characterized by vomiting, fever and swellings of the lymph nodes called ‘buboes’ pneumonic plague, in which the lungs are infected; and septicaemic plague, in which the bloodstream is invaded. Treatment is the administration of vaccines, bed rest, antibiotics and sulpha drugs. See also Black Death

plague †blow, wound; affliction; malignant epidemic, pestilence, XIV. — L. plāga stroke, wound (Vulg.) pestilence, infection, prob. — Gr. (Doric) plāgā́, (Attic) plēgḗ, f. *plāg- strike, rel to L. plangere.
Hence vb. XV.

Plague

a group which, by their size, number, or nature, cause devastation or irritation.

Examples : plague of confessors, 1604; of gnats, 1847; of hail, 1382; of infidels, 1596; of locusts, 1774; of brass money, 1855; of rain and water, 1548; of fell (foul) tempest, 1513.

plague •Craig, Hague, Haig, plague, taig, vague