The recent outbreak of plague in China resulting in deaths of 3 persons led to the complete sealoff or quarantine of a town of 10000 persons. This episode brings back the spotlight on Plague. A multimedia rich article is provided. The impact of plague from the Black Death of the middle ages in Europe, its coverage in our mainstream literature classics and the fear it still provokes in humans is discussed. Plague if left untreated kills 60% of its victims. The disease if detected early can be treated with antibiotics, vaccine use is limited to healthcare persons dealing with the patients and infected animals. Plague was never wiped out from the globe and outbreaks occur fairly regularly in communities in close contacts/interactions with animals mainly in the developing countries. The last outbreak of Plague in India in 1996 resulted in loss of $3 billion due to ban of imports and travel advisory by rich countries. Financial impact of the disease is huge in poor economies. The first pandemic to strike the humanity mentioned in the Exodus.
This knol is cited in Google Scholar
This knol is cited in Google Scholar
Plague has accompanied mankind since prehistoric times and is mentioned in ancient scriptures. It has killed over 200 million patients during our history. During the rapid urbanization of Europe and poor hygienic and sanitary conditions during the 14th century, outbreaks of plague (Black death) were frequent and the disease wiped out almost 50% of European population. Plague outbreaks continued till the 19th century and disease was contained gradually by improved sanitation and hugiene. The discovery of antibiotics and their use after World war II finally defeated the bacteria which had struck terror, fear and anguish in humans. Plague has been described as a human scourge since antiquity.
CDC PHIL 6721 Image of Y pestis with a fluorescent antibody
Yersinia pestis bacteria Imaged with a Fluorescent Antibody
CDC PHIL ID 6721
Hosts of the infection
Hosts of the bacterium are many (more than 200) species of rodents including rats (Rattus rattus and R. norvegicus), lagomorphs (rabbits and hares), but also humans. Even birds have been found to be infected, and they may spread the bacterium over long distances. Some rodents are highly resistant to the disease, i.e., show no or few symptoms although harbouring the bacterium. Such species are important because they act as reservoirs that contribute to the maintenance of so-called “natural foci” (i.e., areas in which the bacterium is naturally maintained, containing communities of bacteria, vectors, reservoir and other hosts).
Fleas of many (more than 120) species are capable of transmitting the infection (including the common flea of humans Pulex irritans), but the most important vector is the cosmopolitan oriental rat flea Xenopsylla cheopis, with several other species of Xenopsylla as well as Nosopsyllus fasciatus of secondary importance. Pulex irritans is less important as a vector because it is rarely in contact with rats and other rodents. Nevertheless, it has contributed to smaller outbreaks of the disease.
File:Xenopsylla cheopis flea PHIL 2069
Xenopsylla cheopis, the oriental rat flea and most important vector of plague
Mode of infection
Fleas transmit the infection to vertebrates by injecting bacteria when biting them, although – more rarely – infection can also occur by rubbing fleas’ faeces or bodies into wounds, or by ingesting fleas. An important factor in the effectiveness of a flea species as a vector is the degree to which its proventriculus (part of the foregut) can be blocked by the bacteria: enzymes produced by the fleas and the bacteria cause coagulation of the ingested blood and thus blockage; consequently fleas begin to starve and become dehydrated, leading to repeated attempts to suck blood and an increase in the likelihood of infecting hosts. In Xenopsylla cheopis, blockages occur rapidly and frequently, which partly explains its importance as a vector of human plague. Other reasons include its world-wide distribution, and association with domestic rats and humans (on which it readily feeds). – The role of temperature is important. The blockages of the fleas’ proventriculus are dissolved at temperatures above 27.5o C, as a result the bacteria are eliminated from the gut. On the other hand, Xenopsylla cheopis thrives best at temperatures of about 23.5oC. Therefore the worst plague epidemics can be expected at 20-25oC, which corresponds to summer/autumn in temperate and to the cooler months in tropical countries.
Epizootics (among animals) and epidemics (among humans)
Plague epidemics among humans appear to commonly follow epizootics among rats: large numbers of rats are killed by the disease and fleas now jump to humans as alternative hosts, thus spreading the disease to them. But there also is a sylvatic and campestral cycle involving humans: during epizootics among wild rodents (in wooded = sylvatic habitats, or in open = campestral habitats) humans in contact with them may become infected.
The incubation period may last from 2-6 days after first infection. when untreated, bacteria spread from the bubo to invade the blood stream leading to the severe and often fatal form Septicemic plague. infections of the lungs by Y. pestis leads to Pneumonic plague.
Bubonic Plague is indicated by swollen lymph glands (Bubo) and pain. The highly contagious Pneumonic plague is due to infections of the lungs by Yersinia pestis and is characterized by Flu like symptoms. The patient may have high fever, cough, bloody sputum and breathing difficulty.
Types of plague symptoms
Three main types of human plague can be distinguished, i.e. bubonic plague, primary septicemic plague and primary pneumonic plague. The first is characterized by “buboes”, swollen lymph nodes in the groins, arm pits or neck as large as a chicken egg, which contain bacteria and may rupture. The second is a general infection of the blood with no or little evidence of a prior swelling of the lymph nodes. In the third, the lungs are heavily involved and the pneumonia-like symptoms (coughing or sneezing) lead to direct (i.e. without involvement of fleas) spreading between humans. – Secondary septicemic plague occurs usually in pneumonic and occasionally in bubonic plague. It is a generalized blood infection following symptoms of bubonic or pneumonic plague. – The incubation period in humans (the symptomless period after an infected flea has bitten) is normally 2 – 4 days. First symptoms include chill and high fever, and a swelling of the lymph nodes. If a patient survives (as the great Roman emperor Justinian did in the 5th century AD), the fever goes down after 2-5 days. Death may occur within 5 days, preceded by mental dullness, delirium, lethargy and coma.
CDC PHIL ID 5
Treatment of plague
Mass and sudden deaths of rodents (rat falls) have remained the first indication of likely plague outbreaks since human history. Field investigation of small wild animals is conducted to determine the extent of Y. pestis contamination and its danger to humans.
Quarantine and Containment
The concept of Quarantine dates back to 1377 when the rulers of Venice imposed a 30-40 days isolation period for the port of Regusa for ships, crew and all travellers to the the port city. Similar laws and bans were imposed by the Italian and French ports to contain the spread of plague.
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