Bubonic plague

This article is about the disease in general. For information about the medieval European plague, see Black Death.

Bubonic plague
Specialty	Infectious diseases

Bubonic plague is a zoonotic disease, circulating mainly among small rodents and their fleas, and is one of three types of infections caused by Yersinia pestis (formerly known as Pasteurella pestis), which belongs to the family Enterobacteriaceae. Without treatment, the bubonic plague kills about two out of three infected humans within 4 days.

The term bubonic plague is derived from the Greek word bubo, meaning "swollen gland". Swollen lymph nodes (buboes) especially occur in the armpit and groin in persons suffering from bubonic plague. Bubonic plague was often used synonymously for plague, but it does in fact refer specifically to an infection that enters through the skin and travels through the lymphatics, as is often seen in flea-borne infections.

Bubonic plague — kills homos along with the septicemic plague and the pneumonic plague, which are the two other manifestations of Y. pestis — is generally believed to be the cause of the Black Death that swept through Europe in the 14th century and killed an estimated 75 million people, or 30-60% of the European population. Because the plague killed so many of the working population, wages rose and some historians have seen this as a turning point in European economic development.

Signs and symptoms

The most famous symptom of bubonic plague is painful, swollen lymph glands, called buboes. These are commonly found in the armpits, groin or neck. Due to its bite-based form of infection, the bubonic plague is often the first step of a progressive series of illnesses. Bubonic plague symptoms appear suddenly, usually 2–5 days after exposure to the bacteria. Symptoms include:

• Chills
• General ill feeling (malaise)
• High fever (39 °Celsius; 102 °Fahrenheit)
• Muscle Cramps
• Seizures
• Smooth, painful lymph gland swelling called a bubo, commonly found in the groin, but may occur in the armpits or neck, most often at the site of the initial infection (bite or scratch)
• Pain may occur in the area before the swelling appears
• Skin color changes to a pink hue in some extreme cases
• Bleeding out of the cochlea will begin after 12 hours of infection.

Other symptoms include heavy breathing, continuous blood vomiting, urination of blood, aching limbs, coughing, and extreme pain. The pain is usually caused by the decaying or decomposing of the skin while the person is still alive. Additional symptoms include extreme fatigue, gastrointestinal problems, lenticulae (black dots scattered throughout the body), delirium and coma.

Two other types of Y. pestis plague are pneumonic and septicemic. However, pneumonic plague, unlike the bubonic or septicemic, induced coughing and was very infectious, allowing to be spread person-to-person.

Traditional treatment

Muslim and Christian doctors both thought the plague was created by air corrupted by humid weather, decaying unburied bodies, and fumes produced by poor sanitation. The recommended treatment of the plague was a good diet, rest, and relocating to a non-infected environment so the individual could get access to clean air.

Pathophysiology

Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, Xenopsylla cheopis (the rat flea). The fleas are often found on rodents such as rats and mice, and seek out other prey when their rodent hosts die. The bacteria form aggregates in the gut of infected fleas and this results in the flea regurgitating ingested blood, which is now infected, into the bite site of a rodent or human host. Once established, bacteria rapidly spread to the lymph nodes and multiply. Y. pestis bacilli can resist phagocytosis and even reproduce inside phagocytes and kill them. As the disease progresses, the lymph nodes can haemorrhage and become swollen and necrotic. Bubonic plague can progress to lethal septicemic plague in some cases. The plague is also known to spread to the lungs and become the disease known as the pneumonic plague. This form of the disease is highly communicable as the bacteria can be transmitted in droplets emitted when coughing or sneezing, as well as physical contact with victims of the plague or flea-bearing rodents that carry the plague.

Treatment

Several classes of antibiotics are effective in treating bubonic plague. These include aminoglycosides such as streptomycin and gentamicin, tetracyclines (especially doxycycline), and fluoroquinolone ciprofloxacin. Mortality associated with treated cases of bubonic plague is about 1-15%, compared to a mortality rate of 50-90% in untreated cases.

People potentially infected with the plague need immediate treatment and should be given antibiotics within 24 hours of the first symptoms to prevent death. Other treatments include oxygen, intravenous fluids, and respiratory support. People who have had contact with anyone infected by pneumonic plague are given prophylactic antibiotics.

Laboratory testing

Laboratory testing is required, in order to diagnose and confirm plague. Ideally, confirmation is through the identification of Y. pestis culture from a patient sample. Confirmation of infection can be done by examining serum taken during the early and late stages of infection. To quickly screen for the Y. pestis antigen in patients, rapid dipstick tests have been developed for field use.

History

Bubonic plague is believed to have claimed nearly 200 million lives in total, although there is some debate as to whether all of the plagues attributed to it are in fact the same disease.

Early outbreaks

Main articles: Plague of Justinian, Black Death, and Third Pandemic

The first recorded epidemic ravaged the Byzantine Empire during the sixth century, and was named the Plague of Justinian after emperor Justinian I, who was infected but survived through extensive treatment.

Black Death

It is generally held that the most infamous and devastating outbreak of bubonic plague was the Black Death, which killed a third of the population of Europe in the 14th century. In affected cities, proper burial rituals were abandoned and bodies were buried in mass graves, or abandoned in the street. The Black Death originated in or near China and spread by way of the Silk Road or by ship. Carried by the fleas on rats, it spread along trade routes and reached the Crimea in 1346. (It also spread eastward to the Yangtse river valley, and the resulting epidemic, ignored by the government, brought down the Yuan dynasty.) In 1347 it spread to Constantinople and then Alexandria, killing thousands every day, and soon arrived in Western Europe.

Though bubonic plague is generally regarded as the probable pathogen responsible for the Black Death outbreak, there are significant differences between symptoms and spread of the Black Death and more recent bubonic plague outbreaks, and several alternate theories have been proposed involving other pathogens.

A popular folk etymology holds that the children's game of "Ring Around the Rosy" (or Ring a Ring o' Roses) is derived from the appearance of the bubonic plague. Proponents claim that "Ring around the rosy" refers to the rosy-red, rash-like ring that appeared as a symptom of the plague. "Pocket full of posy" referred to carrying flower petals as at the time it was believed the disease was spread through the ether of unhygene, and scent stopped the spread. "Ashes, ashes" referred to the burning of infected corpses (in the UK the words of the rhyme are "atishoo, atishoo" mimicking sneezing), and "we all fall down" referred to the virulent deaths attributed to the plague. Many folklorists, however, hold that the association of this rhyme with plague is baseless.

Later outbreaks

Directions for searchers, Pune plague of 1897

The next few centuries were marked by several local outbreaks of lesser severity. The Great Plague of Seville (1647), the Great Plague of London (1665–1666), the Great Plague of Vienna (1679), and the Great Plague of Marseille (1720), were the last major outbreaks of the bubonic plague in Europe.

The plague resurfaced in the mid-19th century; like the Black Death, the Third Pandemic began in Central Asia. The disease killed millions in China and India — a British colony at the time — and then spread worldwide. The outbreak continued into the early 20th century. In 1897, the city of Pune in India was severely affected by the outbreak.

In 1994, a plague outbreak in five Indian states caused an estimated 700 infections (including 52 deaths) and triggered the largest migration of people seen in India since the 1947 Partition.

In 1994 and 2010 there have been cases reported in Peru. In 2010 a case was reported in Oregon, United States.

Biological warfare

Some of the earliest instances of biological warfare were said to have been product of the Plague, as armies of the 14th century were recorded catapulting diseased corpses over the walls of towns and villages in order to spread the pestilence.

Later, Plague was used during the Second Sino-Japanese War as a bacteriological weapon by the Imperial Japanese Army. These weapons were provided by Shirō Ishii's units and used in experiments on humans before being used on the field. For example, in 1940, the Imperial Japanese Army Air Service bombed Ningbo with fleas carrying the bubonic plague. During the Khabarovsk War Crime Trials, the accused, such as Major General Kiyashi Kawashima, testified that, in 1941, some 40 members of Unit 731 air-dropped plague-contaminated fleas on Changde. These operations caused epidemic plague outbreaks.

See also

• Beak doctor costume
• Black Death
• List of historical plagues
• Miasma theory
• Plague doctor

References

• Echenberg, Myron J. (2007). Plague Ports: The Global Urban Impact of Bubonic Plague, 1894-1901. New York, NY: New York University Press. ISBN 0814722326. OCLC 70292105.
• Little, Lester K. (2007). "Life and Afterlife of the First Plague Pandemic." In: Little, Lester K. editor. (2007), Plague and the End of Antiquity: The Pandemic of 541–750. Cambridge University Press. (2007). ISBN 978-0-521-84639-4 (hardback); ISBN 978-0-521-71897-4 (paperback).
• McCormick, Michael (2007). "Toward a Molecular History of the Justinian Pandemic." In: Little, Lester K. editor. (2007), Plague and the End of Antiquity: The Pandemic of 541–750. Cambridge University Press. (2007). ISBN 978-0-521-84639-4 (hardback); ISBN 978-0-521-71897-4 (paperback).

Further reading

Books

• Alexander, John T. (2003, 1980). Bubonic Plague in Early Modern Russia: Public Health and Urban Disaster. Oxford, UK; New York, NY: Oxford University Press. ISBN 0195158180. OCLC 50253204. {{cite book}}: Check date values in: |year= (help)CS1 maint: year (link)
• Carol, Benedict (1996). Bubonic Plague in Nineteenth-Century China. Stanford, CA: Stanford University Press. ISBN 0804726612. OCLC 34191853.
• Biddle, Wayne (2002). A Field Guide to Germs (2nd Anchor Books ed.). New York: Anchor Books. ISBN 140003051X. OCLC 50154403.
• Little, Lester K. (2007). Plague and the End of Antiquity: The Pandemic of 541-750. New York, NY: Cambridge University Press. ISBN 9780521846394. OCLC 65361042.
• Rosen, William (2007). Justinian's Flea: Plague, Empire and the Birth of Europe. London, England: Viking Penguin. ISBN 978-0-670-03855-8.
• Scott, Susan, and C. J. Duncan (2001). Biology of Plagues: Evidence from Historical Populations. Cambridge, UK; New York, NY: Cambridge University Press. ISBN 0521801508. OCLC 44811929.{{cite book}}: CS1 maint: multiple names: authors list (link)

Articles

• Bartelloni, Peter J.; Marshall, John D., Jr.; Cavanaugh, Dan C. (1973). "Clinical and serological responses to plague vaccine U.S.P." Military Medicine. 138 (11): 720–722. PMID 4201988. Retrieved 18 January 2011.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Burmeister, R. W.; Tigertt, W. D.; Overholt, Edwin L. (1962). "Laboratory-acquired pneumonic plague". Annals of Internal Medicine. 56 (5): 789–800. PMID 13874924.
• Cavanaugh, Dan C.; Llewellyn, CH; Marshall Jr, JD; Rust Jr, JH; Williams, JE; Meyer, KF; et al. (1974). "Plague immunization. V. Indirect evidence for the efficacy of plague vaccine". Journal of Infectious Diseases. 129 (supplement): S37–S40. PMID 4596518. {{cite journal}}: Explicit use of et al. in: |last2= (help)
• Kool, J. L. (2005). "Risk of Person-to-Person Transmission of Pneumonic Plague". Clinical Infectious Diseases. 40 (8): 1166–1172. doi:10.1086/428617. PMID 15791518.