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Plague, pneumonic
plague, septicemic plague, or black
death
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- Plague is an infection
transmitted from rodents to humans by fleas. An infected flea bites a human, transmitting the disease. This disease can also be transmitted by accidentally ingesting flea feces or can be transmitted from someone with plague pneumonia (lung infection) via coughing, thereby passing plague bacteria to another
person.
- The disease is present in third world countries and is endemic (i.e., present at all times) in the S.W., USA (the general area of California, Nevada, Arizona, and Utah). Plague is rare in areas with
good sanitation and rodent population
control.
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- Symptoms appear 2-10 days after exposure to Bubonic
plague
- BP (Bubonic Plague):
- High Fever
- Chills
- Headache
- Weakness
- Muscle aches
- Joint aches
- Poor appetite
- There may be reddened areas, pus,
fluid-filled sacs (Vesicles), or burn-like slough (eschar)
where the flea bite occurred.
- Buboes (enlarged lymph nodes in the groin, armpits,
neck, and other sites.
- Buboes can get as large as eggs.
- Black-purple spots can appear under the
skin.
- Symptoms of BP (can occur without
BP symptoms)
- Seizures
- Shock
- Confusion
- Bleeding tendency
- With BP or SP
- Symptoms occur within hours --
one day after inhalation of bacteria
- Cough
- Frothy sputum (what is coughed
up)
- Coughing blood
- Chest pain
- Shortness of breath
- Confusion
- Bluish tinge to skin and lips
(cyanosis)
- Shock
- Death
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- Bacteria -- Yersinia pestis causes the so-called Bubonic plague (BP), which is
characterized by buboes, swollen lumps that are reddened,
smooth, painful, and tender. These lumps are swollen lymph
nodes that act as a filter to keep bacteria and other
invaders out of the blood stream.
- The bacteria can spread to the blood (septicemic plague, SP). The
bacteria can be inhaled into the lungs and cause pneumonic
plague (PP). Infected cats can also transmit the
bacteria by scratching or biting
humans.
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- History of exposure
- Medical evaluation:
- Physical signs of infection
(e.g., buboes)
- Low blood pressure
- High fever
- Rapid heart rate
- Rapid breathing
- Bluish lips and skin
- Swollen lymph nodes
- Liver and spleen may be enlarged.
- Blood, urine, sputum, and fluid
from buboes or other lesions are collected and sent
immediately to a laboratory where the bacteria are grown
and identified (cultures).
- The secretions from buboes, sputum,
and blood can also be stained with a dye (gram stain).
When examined under a microscope, it will show the bacteria
of Y. pestis.
- Blood samples will show an
elevation of the number of white blood cells (body's
soldiers) low number of platelets (cells that stop
bleeding), and low oxygen levels.
- Biopsy or sample of the buboes
will show the bacteria.
- Chest x-ray will show
patchy areas in the lungs in PP.
- Echocardiography uses sound waves to generate a picture to show fluid around the heart (seropurulent pericarditis).
- Spinal fluid is removed (spinal
tap) if spread of infection to the membranes covering the
brain is suspected.
- Public health authorities will need to be notified if a diagnosis of the plague is
confirmed.
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- Third world countries where rodent
population is out of control
- Skinning wild animals
- Workers in laboratories where Y.
pestis is grown
- Healthcare workers taking care of patients with pneumonic plague
- War zones
- Famine
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- Admit to hospital.
- Isolate from other patients for 48
hours after effective therapy is started or cultures are
negative.
- Gloves must be worn at all times
when in contact with the infected individual.
- Avoid contact with all bodily
fluids (urine, sputum, saliva, blood, and semen).
- Fluids are given intravenously --
IV (via the veins)
- Oxygen may be needed.
- If in shock or having seizures, appropriate
medications are given.
- Antibiotics IV such as streptomycin
or gentamicin are given.
- Rarely, if patient is not too sick, antibiotics
by mouth, such as tetracycline can be used.
- If the heart stops or the patient
cannot breath (or stops breathing), start CPR and put
him on a respirator (breathing machine) immediately. The persons performing CPR
must protect their own airways.
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-
Plague spreads very rapidly
and can be fatal.
The general public should avoid all contact with infected rodents
and patients. Immediate treatment and notification of
authorities is a must. The faster one gets treatment, the
better the chances of
survival.
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