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Picture Courtesy: https://netec.org/2022/08/08/plague-symptoms-treatment-and-infection-prevention/

Context: In February 2024, the USA confirmed a rare case of bubonic plague, believed to be transmitted by a pet cat.

What is the bubonic plague?

• The bubonic plague is a bacterial infection caused by Yersinia pestis, a rod-shaped bacterium that lives in rodents and their fleas. It can be transmitted to humans through flea bites or contact with infected animals or their tissues.
• The bacteria enter the lymphatic system and cause swollen, painful lymph nodes called buboes, hence the name bubonic plague. It can also spread to other parts of the body, such as the lungs (causing pneumonic plague) or the bloodstream (causing septicemic plague).

The bubonic plague, also known as the Black Death, was one of the deadliest pandemics in human history. It killed an estimated 25 to 50 million people in Europe in the 14th century, wiping out about half of the population.

What are the symptoms of the bubonic plague?

• The symptoms of the bubonic plague usually appear within two to six days after exposure to the bacteria. They include Fever, Headache, Muscle pain, Weakness, Nausea and vomiting, and swollen and tender lymph nodes (buboes) in the groin, armpit, or neck.
• If left untreated, the bubonic plague can cause serious complications, such as:
  • Gangrene (tissue death) of the fingers, toes, or nose
  • Meningitis (inflammation of the membranes around the brain and spinal cord)
  • Sepsis (a life-threatening infection of the blood)
  • Respiratory failure
  • Death

How common is the bubonic plague in 2024?

• The bubonic plague is still around in 2024, but it is much less common and much more treatable than it was in the middle Ages.
• According to the World Health Organization (WHO), there were 3,248 cases of plague reported worldwide between 2010 and 2019, resulting in 584 deaths. Most of these cases occurred in Africa, especially in Madagascar, where periodic outbreaks have been reported since 2014. Other regions where plague is endemic include Asia, South America, and the western areas of North America.

How is the bubonic plague diagnosed and treated?

• The diagnosis of the bubonic plague is based on clinical symptoms and laboratory tests. The laboratory tests include:
  • Blood culture: A sample of blood is taken and grown in a special medium to detect the presence of Yersinia pestis bacteria.
  • Lymph node aspiration: A needle is inserted into a swollen lymph node and a fluid sample is taken and examined under a microscope for Yersinia pestis bacteria.
  • Polymerase chain reaction (PCR): A technique that amplifies and detects the DNA of Yersinia pestis bacteria from blood or tissue samples.
• The treatment of the bubonic plague consists of antibiotics that kill the bacteria, such as streptomycin, gentamicin, doxycycline, or ciprofloxacin. The antibiotics should be started as soon as possible after exposure or symptom onset to prevent complications and death. The treatment usually lasts for 10 to 14 days.
• In addition to antibiotics, supportive care may be needed for patients with severe symptoms or complications, such as:
  • Fluids and electrolytes to prevent dehydration
  • Oxygen therapy to improve breathing
  • Blood transfusion to replace lost blood
  • Surgery to remove dead tissue or drain infected fluids

How can the bubonic plague be prevented?

• The prevention of the bubonic plague depends on reducing the risk of exposure to infected rodents or their fleas. Some preventive measures include:
  • Avoid contact with sick or dead animals.
  • Wearing gloves and long-sleeved clothing when handling or skinning animals.
  • Applying insect repellent to skin and clothing when outdoors.
  • Using flea control products on pets and keeping them away from wild rodents.
  • Cleaning and disinfecting rodent habitats and nesting materials.
  • Reporting any suspected cases of plague to local health authorities.
• In some areas where plague is endemic, antibiotics may be given to people who have been exposed to infected animals or their fleas, or who have had close contact with plague patients. A vaccine against plague is also available, but it is not widely used due to its limited effectiveness and potential side effects.

Conclusion

• The bubonic plague is a serious and potentially fatal disease that has plagued humanity for centuries. However, with modern medicine and public health measures, it is no longer the scourge that it once was.

PRACTICE QUESTION Q. Which of the following factors pose the greatest potential threat for future outbreaks of bubonic plague? A) The emergence of a new, antibiotic-resistant strain of Yersinia pestis. B) The increasing availability of flea and tick prevention medication for pets. C) The improved sanitation standards in most developed countries. D) The widespread use of personal protective equipment (PPE) by the public. Answer: A Explanation: The greatest potential threat for future outbreaks of bubonic plague would likely be the emergence of a new, antibiotic-resistant strain of Yersinia pestis, the bacterium responsible for causing the plague. Currently, antibiotics are effective in treating and controlling the disease, but the development of antibiotic resistance could significantly compromise our ability to manage and treat bubonic plague. Bubonic plague is primarily transmitted through the bite of infected fleas, which often infest rodents. While factors like the increasing availability of flea and tick prevention medication for pets (Option B) could contribute to reducing the risk of transmission, the emergence of antibiotic resistance in Yersinia pestis would directly impact our ability to treat and control the disease. Options C and D, which involve improved sanitation standards in developed countries and the widespread use of personal protective equipment (PPE), respectively, are not direct factors influencing the bacterium's resistance to antibiotics or the transmission dynamics of the disease. While they play crucial roles in preventing the spread of infectious diseases, they may not be as directly linked to the potential threat of antibiotic-resistant strains as Option A.