Bubonic plague

The most common form of the plague in humans; characterized by chills, prostration, delirium and the formation of buboes in the armpits and groin; does not spread from person to person.

Plague is an infectious disease caused by the gram-negative bacterium Yersinia pestis. It is transmitted primarily through the bite of infected rodent fleas. Less common exposure routes include handling infected animal tissues (e.g., hunters, wildlife personnel), inhaling infectious droplets from cats or dogs with plague, and, rarely, contact with a pneumonic plague patient.

Epidemiology

Bubonic plaque

Plague is endemic to rural areas in central and southern Africa (especially eastern Democratic Republic of Congo, northwestern Uganda, and Madagascar), central Asia and the Indian subcontinent, the northeastern part of South America, and parts of the southwestern United States. The overall risk to travelers is low.

Clinical Presentation

The incubation period for plague is typically 1-6 days. Symptoms and signs vary depending on the specific form of plague illness:

Bubonic Plague

The most common form of plague, bubonic plague, is characterized by rapid onset of fever and painful, swollen, and tender lymph nodes, usually in the inguinal, axillary, or cervical regions.

Pneumonic Plague

Pneumonic plague presents with high fever, overwhelming pneumonia, cough, bloody sputum, and chills.

Septicemic Plague

In cases of septicemic plague, patients experience fever, prostration, hemorrhagic or thrombotic phenomena, and progression to acral gangrene.

Diagnosis

Diagnosing plague involves isolating Y. pestis from bubo aspirates, blood cultures, or sputum cultures in cases of pneumonic plague. Public health laboratories can confirm the diagnosis using culture or serologic tests for the Y. pestis F1 antigen. Plague is a nationally notifiable disease.

Treatment

Plague can be treated with various antibiotics, including gentamicin, doxycycline, ciprofloxacin, and levofloxacin. Parenteral antibiotic moxifloxacin may also be used. Alternative treatments include parenteral streptomycin and chloramphenicol.

Prevention

To prevent plague, it is important to reduce contact with fleas and potentially infected rodents and other wildlife. No plague vaccine is currently available for commercial use in the United States. Antibiotics can be used for post-exposure prophylaxis.

Precautions for Travelers

Travelers visiting areas where plague is endemic can take several precautions to minimize their risk of infection:

• Avoid close contact with live or dead animals, particularly rodents.
• Use insect repellent containing DEET, picaridin, IR3535, or oil of lemon eucalyptus to protect against fleas.
• Wear long sleeves, long pants, and closed-toe shoes to minimize skin exposure.
• Avoid sleeping on the ground or in areas where rodents may be present.
• Maintain a safe distance from people who are coughing or appear to be seriously ill.
• Do not handle or touch any sick or dead animals.

Post-Exposure Prophylaxis

In cases of potential exposure to Yersinia pestis, post-exposure prophylaxis with antibiotics may be recommended. This typically involves taking doxycycline or ciprofloxacin for 7 days following the exposure. Healthcare providers should be consulted for specific recommendations based on individual circumstances.

Reporting and Surveillance

As a nationally notifiable disease, healthcare providers and laboratories are required to report suspected and confirmed cases of plague to local or state health departments. These departments then report cases to the Centers for Disease Control and Prevention (CDC) for further analysis and tracking. Surveillance and reporting help identify outbreaks, monitor trends, and develop public health strategies to control the spread of plague.

Ongoing Research and Future Developments

Researchers continue to study the biology of Yersinia pestis and the factors that contribute to plague outbreaks in order to develop more effective treatments, diagnostics, and preventive measures. This includes efforts to create a safe and effective vaccine for plague, as well as research on novel antibiotics and antivirals that could be used to combat the disease. Additionally, scientists are investigating the ecology of plague-carrying rodents and their fleas, aiming to better understand and predict the factors that lead to the emergence of plague in human populations.

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