plague

What is Plague?

Plague is a serious infectious disease caused by the bacterium Yersinia pestis, which affects humans and other mammals [1]. It is primarily found in small rodents and their fleas, where it can be transmitted between animals and humans through bites from infected fleas [3].

Causes of Plague

The plague is an infectious disease that spreads through the bite of infected fleas, which are usually found on small mammals such as rats, mice, and squirrels [2]. The bacteria can also be transmitted directly from person to person through respiratory droplets or by contact with infected bodily fluids.

Symptoms of Plague

The symptoms of plague include fever, headache, chills, weakness, and the formation of swollen, painful lymph nodes (called buboes) in one or more areas of the body [6]. In severe cases, the disease can progress to septicemic plague, which is a life-threatening condition that requires immediate medical attention.

Types of Plague

There are three main forms of plague: bubonic, pneumonic, and septicemic. Bubonic plague is the most common form, characterized by the formation of swollen lymph nodes (buboes) in the groin, armpits, or neck [6]. Pneumonic plague is a more severe form that affects the lungs and can be transmitted from person to person through respiratory droplets.

References

[1] May 15, 2024 — Overview. Plague is a disease that affects humans and other mammals. [2] Apr 20, 2023 — Overview. Plague is a serious illness caused by a germ called Yersinia pestis. [3] Plague is a zoonotic disease, which means you can get it from animals and they can get it from you. [6] May 15, 2024 — Bubonic plague: Patients develop fever, headache, chills, and weakness and one or more swollen, painful lymph nodes (called buboes). [8] Oct 20, 2022 — What is plague? Plague is a disease caused by a kind of bacteria.

The signs and symptoms of plague can vary depending on the type of plague, but common symptoms include:

• Fever: A sudden high fever is a hallmark symptom of pneumonic plague [2].
• Chills: Chills are another common symptom of all three types of plague: bubonic, septicemic, and pneumonic [1][3][4].
• Headache: Headaches can occur in people infected with the plague [1][6].
• Malaise: A general feeling of illness or discomfort is a non-specific systemic symptom that can occur in people infected with the plague [3].
• Swollen, painful lymph nodes (buboes): Bubonic plague is characterized by swollen and tender lymph nodes near the site of a flea bite [4][6].

In addition to these symptoms, pneumonic plague can also cause:

• Cough: A cough with bloody mucus is a symptom of pneumonic plague [2].
• Difficulty or irregular breathing: People with pneumonic plague may experience difficulty or irregular breathing [2].
• Chest pain: Chest pain can occur in people with pneumonic plague [2].

Septicemic plague, on the other hand, can cause:

• Blackened tissue from gangrene: Gangrene of fingers or toes is a symptom of septicemic plague [5].
• Unusual bleeding: Unusual bleeding can also be a symptom of septicemic plague [5].

It's worth noting that most cases of plague resolve with effective treatment, though prompt medical attention is essential to prevent complications and death [8].

Diagnostic Tests for Plague

Plague diagnosis involves several tests to confirm the presence of the Yersinia pestis bacteria in the body. Here are some of the diagnostic tests used to diagnose plague:

• Blood or tissue sample tests: These tests involve taking a blood or tissue sample from the patient and sending it to the lab for testing to see if Yersinia pestis is present [6].
• Culture and PCR (Polymerase Chain Reaction) tests: These tests are used to detect the presence of Yersinia pestis in the body. If culture and PCR show negative results, serologic testing may be possible to confirm the diagnosis [7].
• Rapid Diagnostic Test (RDT): A rapid diagnostic test could help prompt diagnosis of plague, especially in low-resource settings. This would improve patient care and treatment outcomes [9].

Additional Tests

In some cases, additional tests may be performed to rule out other conditions or to confirm the diagnosis of plague. These may include:

• Fluid from buboes: Fluid from the swollen lymph nodes (buboes) can be tested for Yersinia pestis [2].
• Blood: Blood samples can also be tested for Yersinia pestis [2].
• Mucous from the lungs: Mucous from the lungs can be tested for Yersinia pestis in cases of pneumonic plague [2].

References

[1] May 15, 2024 — Doctors examining a bubo caused by plague. Diagnosis. [6] To diagnose bubonic plague, your healthcare provider will order blood or tissue sample tests. [7] Oct 13, 2017 — If culture and PCR show negative results and plague is still suspected, serologic testing is possible to confirm the diagnosis. [9] Jun 26, 2020 — A rapid diagnostic test (RDT) could help prompt diagnosis of plague, especially in low-resource settings.

Treatment Options for Plague

The treatment of plague typically involves antibiotics, which can be effective in curing the disease if administered promptly.

• First-line treatments: Gentamicin and fluoroquinolones are commonly used as first-line treatments for plague in the United States [2][5].
• Approved medications: The FDA has approved levofloxacin and moxifloxacin for the treatment of plague, which can also be used as prophylaxis following exposure to the disease [3].
• Other antibiotics: Aminoglycosides and fluoroquinolones are the mainstays of treatment for plague, while tetracyclines, chloramphenicol, and trimethoprim-sulfamethoxazole may also be used in some cases [7].
• Broad-spectrum treatments: Some research groups are developing broad-spectrum therapeutic strategies against plague, which can target multiple bacterial infections [4].

It is essential to seek medical attention as soon as possible for diagnosis and treatment of plague to reduce the risk of complications and death.

References: [1] Not applicable [2] May 15, 2024 [3] Jun 17, 2024 [4] by F Sebbane · 2021 · Cited by 35 [5] The bubonic plague can be treated and cured with antibiotics. [6] All forms of plague are treated with antibiotics. [7] Jun 17, 2024

The differential diagnosis of plague, a highly infectious disease caused by the bacterium Yersinia pestis, involves considering various conditions that can present with similar symptoms.

Possible Differential Diagnoses

• Streptococcal or staphylococcal adenitis: This condition can cause swollen lymph nodes, fever, and pain in the affected area, similar to bubonic plague [2].
• Tularemia: Also known as rabbit fever, tularemia is a bacterial infection that can cause symptoms such as fever, chills, and swollen lymph nodes, which can be mistaken for pneumonic plague [3].
• Cat scratch disease (cat scratch fever): This condition is caused by the bacterium Bartonella henselae and can present with symptoms such as swollen lymph nodes, fever, and a rash, similar to bubonic plague [8].
• Mycobacterial infection: Certain types of mycobacteria, such as Mycobacterium tuberculosis, can cause infections that may be mistaken for pneumonic plague due to similar symptoms [2].

Other Considerations

• Gram-negative sepsis: This condition is a severe and potentially life-threatening infection caused by gram-negative bacteria, which can present with symptoms similar to septicemic plague [5].
• Community-acquired pneumonia: Certain types of community-acquired pneumonia, such as pneumococcal or staphylococcal pneumonia, can be mistaken for pneumonic plague due to similar symptoms [3].

Important Note

It's essential to note that prompt diagnosis and treatment are crucial in preventing complications and death from plague. A high index of clinical suspicion, a careful clinical and epidemiologic history, and a thorough physical examination are required to make a timely diagnosis [6].