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Overview of the Plague: Understanding the symptoms and causes

Dr. Ajay KohliOct 14, 2022

Once known as the mediaeval’s "Black Death", Plague is a life-threatening, infectious disease that, although rare, still exists today. The disease is widespread on all continents; however, most cases are seen where rodent populations are high. Symptoms typically include an abrupt onset of chills, fever, and enlarged painful lymph nodes. The illness is treatable with modern antibiotics and supportive therapy. Yet, if left untreated, it causes serious complications and, sometimes, even death.

Plague

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What is Plague?

Plague is a zoonotic (meaning it spreads between animals and humans) disease caused by the bacterium Yersinia pestis, whose natural life cycle includes rodents and fleas, with humans being affected accidentally. 

Clinically, Plague can manifest in different forms, although the most common are bubonic, pneumonic, and septicaemic. The bubonic type is the mildest, affecting lymph nodes, while the other two are the rarest and deadliest, impacting the blood and lungs. 

Signs and symptoms of the Plague

Symptoms of Plague vary depending on how exposed you are to the bacteria and the clinical form you eventually develop. In most cases, the infection usually starts with flu-like indications after 1 to 7 days of exposure. Then, it rapidly progresses to a bubonic, pneumonic, or septicaemic form. 

Symptoms may comprise the following.

  • Fever 

  • Chills 

  • Head and body aches

  • Extreme weakness and fatigue

  • Swollen and painful lymph nodes (Bubonic Plague)  

  • Bleeding from the nose, mouth or underneath the skin (Septicaemic Plague) 

  • Blackening of fingers, toes, and nose (Septicaemic Plague)

  • Nausea and vomiting

  • Diarrhoea

  • Stomach pain

  • Rapid heartbeat 

  • Troubled breathing (Pneumonic Plague)

  • Chest pain and cough with blood (Pneumonic Plague)

Symptoms are treatable when caught on time. So, if you are experiencing any of the above symptoms, consult the doctor immediately to prevent serious complications or death. 

What causes the Plague?

The most common way a Plague can transmit to humans is through the bites of infected fleas that reside on rodents such as rats, mice, squirrels, and others. The outcome is the bubonic Plague. Here, rodents are the primary reservoirs of Plague bacteria. 

Less frequently, people can also become infected with bubonic or septicaemic Plague by handling tissues and other body fluids from diseased animals (dead or living) without adequate measures. Moreover, it is rare for the bubonic or septicaemic Plague to spread from person to person. 

You can also catch Plague by inhaling the infectious respiratory droplets from individuals suffering from pneumonic Plague (infected lungs). Domestic cats are also vulnerable to this form and can pose a significant risk to their owners, veterinarians and others who come in close contact with them. 

Types of Plagues

Plague is commonly classified into three types based on the body parts infected by the Y. pestis-Bubonic, Septicemic, and Pneumonic. 

Bubonic Plague: It is the most common and survivable form of the disease, characterised by the presence of swollen lymph nodes called buboes. Buboes are often firm and extremely painful and are seen at the groin, armpit (axilla) or neck. Untreated, Bubonic Plague is fatal in about 66% of cases and may lead to other kinds of Plague. 

Pneumonic Plague:Here, the bacterium infects your lungs. The disease can occur either as a complication of the Bubonic Plague or as a primary infection after breathing the bacterium directly into the lungs.Affected individuals can develop severe respiratory symptoms and shock. Left untreated, this form of Plague can rapidly progress to multiple organ failures, leading to death.

Septicaemic Plague:  In this clinical form, the bacterium enters your bloodstream and rapidly spreads to various tissues and organs of your body, causing gangrene and organ failure. Serious complications are likely if not diagnosed and treated promptly.

Treatment for Plague

Being a serious illness, Plague needs prompt care, which involves early detection and timely administration of effective antibiotics. Because without treatment, Plague is always fatal. Therefore, the earlier you seek medical care, the greater the chance of full recovery. 

Some powerful antibiotics recommended for Plague treatment include streptomycin, gentamicin, and tetracycline (doxycycline), given either orally or intravenously. The treatment works well and would last for a week or two unless you have an ongoing fever, other worrying symptoms, or health conditions.

Patients with Pneumonic Plague are generally placed under isolation (like COVID-19 illness) to avoid transmission. Any close contacts who might be at risk of developing Plague are provided with preventive antibiotics known as "post-exposure prophylaxis" or PEP.

Diagnosis of Plague

When your doctor suspects Plague, they make the definitive diagnosis through laboratory detection of Yersinia in the blood, tissues extracted from lymph nodes, and/or spit, if necessary. They can also order an ELISA test to detect the presence of antibodies against the specific protein (F1-capsular antigen) of bacteria. 

However, because the disease spreads fast, your doctor can initiate your treatment based on your history of travel, a recent flea bite, exposure to rodent-infested areas, contact with a sick or dead animal, as well as the Plague-suggested clinical signs and symptoms you may have. 

How can I prevent the Plague? 

As of today, there are no vaccines for the deadly Plague disease. But you can still prevent getting exposed to it by taking the following steps.

  • Avoid travelling in areas endemic to Plague. 

  • Keep your home, office, and other recreational areas rodent-free by filling up the holes and gaps.

  • Use flea control products that contain DEET to protect your pets from fleas.

  • When possible, wear closed-toed shoes and tuck trousers into socks.

  • Do not let your pets wander freely or sleep on your bed.

  • If you're in high-risk areas of the Plague, avoid handling animals (dead or alive).

  • Get your pet to the veterinarian immediately if it feels ill. 

  • Wear insect repellent while outdoors.

  • Wear gloves and masks to avoid contact with people suspected of having the Plague. 

  • Seek medical help and follow instructions if you think you have been exposed to infected rodents or fleas.

Risk factors of Plague

Here are some factors that can increase your risk of contracting the Plague. 

  • Flea bite

  • Close contact with an infected person

  • Contact with sick animals or rodents 

  • Residing in rural and semi-rural areas with large agricultural farms 

  • Camping, hunting, or hiking in areas where Plague-infected animals reside

  • Poor sanitation and living conditions

Frequently Asked Questions (FAQs)

Here are some common queries and their resolutions regarding Plague.

Is Plague contagious?

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Bubonic and Septicaemic forms of Plague aren't contagious. But Pneumonic Plague can get transmitted from person to person through the air during coughing, sneezing and close contact.

Who can get Plague?

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Plagues can occur in both men and women of age 12 to 45. Even the location of someone's home or workplace, such as in rural and semi-rural locations, where homes are built near wild rodent populations, increases one's risk of Plague.

What should I do if I have Plague?

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Get treated immediately Because antibiotics are the only way to improve your chances of recovery if you begin taking them within 24 hours of noticing symptoms. Then again, also expect other supportive care along with antibiotics.

Is Plague seasonal in occurrence?

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Yes. But only during warmer months, when Plague epidemics are recurrent in the wild rodent population, and the infection often spills over to humans due to the death of the natural diseased host. So, it is the flea and hosts' sensitivity to climatic conditions along with the geographical location that decides the seasonal pattern of Plague incidence in humans.

How long does it take to recover from Plague?

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It usually takes 1 to 2 weeks to recover from Plague if you are treated within 24 hours of the onset of symptoms. Otherwise, Plague is fatal.

References

  1. https://doi.org/10.1128/JCM.01519-17

  2. https://doi.org/10.1098/rspb.2020.2725

  3. https://rarediseases.org/rare-diseases/Plague/

  4. https://www.ecdc.europa.eu/en/Plague/facts

  5. https://www.who.int/news-room/fact-sheets/detail/Plague

  6. https://www.cdc.gov/Plague/faq/index.html

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.

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