|A bubo on the upper thigh of a person infected with bubonic plague.|
|Symptoms||Fever, headaches, vomiting, swollen lymph nodes|
|Usual onset||1–7 days after exposure|
|Causes||Yersinia pestis spread by fleas|
|Diagnostic method||Finding the bacterium in the blood, sputum, or lymph nodes|
|Treatment||Antibiotics such as streptomycin, gentamicin, or doxycycline|
|Frequency||650 cases reported a year|
|Deaths||10% mortality with treatment |
30-90% if untreated
Bubonic plague is one of three types of plague caused by bacterium Yersinia pestis .One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting. Swollen and painful lymph nodes occur in the area closest to where the bacteria entered the skin. Occasionally, the swollen lymph nodes may break open.
The three types of plague are the result of the route of infection: bubonic plague, septicemic plague, and pneumonic plague.Bubonic plague is mainly spread by infected fleas from small animals. It may also result from exposure to the body fluids from a dead plague-infected animal. In the bubonic form of plague, the bacteria enter through the skin through a flea bite and travel via the lymphatic vessels to a lymph node, causing it to swell. Diagnosis is made by finding the bacteria in the blood, sputum, or fluid from lymph nodes.
Prevention is through public health measures such as not handling dead animals in areas where plague is common.Vaccines have not been found to be very useful for plague prevention. Several antibiotics are effective for treatment, including streptomycin, gentamicin, and doxycycline. Without treatment, plague results in the death of 30% to 90% of those infected. Death, if it occurs, is typically within ten days. With treatment the risk of death is around 10%. Globally between 2010 and 2015 there were 3248 documented cases, which resulted in 584 deaths. The countries with the greatest number of cases are the Democratic Republic of the Congo, Madagascar, and Peru.
The plague was the cause of the Black Death that swept through Asia, Europe, and Africa in the 14th century and killed an estimated 50 million people.This was about 25% to 60% of the European population. Because the plague killed so many of the working population, wages rose due to the demand for labor. Some historians see this as a turning point in European economic development. The disease was also responsible for the Justinian plague originating in the Eastern Roman Empire in the 6th century CE, as well as the third epidemic affecting China, Mongolia, and India originating in the Yunnan Province in 1855. The term bubonic is derived from the Greek word βουβών, meaning "groin". The term "buboes" is also used to refer to the swollen lymph nodes.
The best-known symptom of bubonic plague is one or more infected, enlarged, and painful lymph nodes, known as buboes. After being transmitted via the bite of an infected flea, the Y. pestis bacteria become localized in an inflamed lymph node, where they begin to colonize and reproduce. Buboes associated with the bubonic plague are commonly found in the armpits, upper femoral, groin and neck region. Bubonic plague symptoms appear suddenly a few days after exposure to the bacterium. Symptoms include:
Other symptoms include heavy breathing, continuous vomiting of blood (hematemesis), aching limbs, coughing, and extreme pain caused by the decay or decomposition of the skin while the person is still alive. Additional symptoms include extreme fatigue, gastrointestinal problems, lenticulae (black dots scattered throughout the body), delirium, coma, and death. Other forms of the disease include septicemic plague and pneumonic plague in which the bacterium reproduces in the persons blood and lungs respectively.
Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, Xenopsylla cheopis (the rat flea). In very rare circumstances, as in the septicemic plague, the disease can be transmitted by direct contact with infected tissue or exposure to the cough of another human. The flea is parasitic on house and field rats, and seeks out other prey when its rodent hosts die. The bacteria remain harmless to the flea, allowing the new host to spread the bacteria. 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 hemorrhage 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.
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.
Samples taken for testing include:
Targeted chemoprophylaxis, sanitation, and vector control played a role in controlling the 2003 Oran outbreak of the bubonic plague.
Several classes of antibiotics are effective in treating bubonic plague. These include aminoglycosides such as streptomycin and gentamicin, tetracyclines (especially doxycycline), and the fluoroquinolone ciprofloxacin. Mortality associated with treated cases of bubonic plague is about 1–15%, compared to a mortality of 40–60% 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.Using the broad-based antibiotic streptomycin has proven to be dramatically successful against the bubonic plague within 12 hours of infection.
Globally between 2010 and 2015 there were 3248 documented cases, which resulted in 584 deaths.The countries with the greatest number of cases are the Democratic Republic of the Congo, Madagascar, and Peru.
For over a decade since 2001, Zambia, India, Malawi, Algeria, China, Peru, and the Democratic Republic of the Congo had the most plague cases with over 1,100 cases in the Democratic Republic of the Congo alone. From 1,000 to 2,000 cases are conservatively reported per year to the WHO.From 2012 to 2017, reflecting political unrest and poor hygienic conditions, Madagascar began to host regular epidemics.
Between 1900 and 2015, the United States had 1,036 human plague cases with an average of 9 cases per year. In 2015, 16 people in the Western United States developed plague, including 2 cases in Yosemite National Park.These US cases usually occur in rural northern New Mexico, northern Arizona, southern Colorado, California, southern Oregon, and far western Nevada.
In November 2017, the Madagascar Ministry of Health reported an outbreak to WHO (World Health Organization) with more cases and deaths than any recent outbreak in the country. Unusually most of the cases were pneumonic rather than bubonic.
In June 2018, a child was confirmed to be the first person in Idaho to be infected by bubonic plague in nearly 30 years.
A couple died in May 2019, in Mongolia, while hunting marmots.Another two people in the province of Inner Mongolia, China were treated in November 2019 for the disease.
In July 2020, in Bayannur, Inner Mongolia of China, a human case of bubonic plague was reported. Officials responded by activating a city-wide plague-prevention system for the remainder of the year.Also in July 2020, in Mongolia, a teenager died from bubonic plague after consuming infected marmot meat.
Yersinia pestis has been discovered in archaeological finds from the Late Bronze Age (~3800 BP).
The first recorded epidemic affected the Sassanian Empire and their arch-rivals, the Eastern Roman Empire (Byzantine Empire) and was named the Plague of Justinian after emperor Justinian I, who was infected but survived through extensive treatment. million people (two centuries of recurrence). The historian Procopius wrote, in Volume II of History of the Wars, of his personal encounter with the plague and the effect it had on the rising empire. In the spring of 542, the plague arrived in Constantinople, working its way from port city to port city and spreading around the Mediterranean Sea, later migrating inland eastward into Asia Minor and west into Greece and Italy. Because the infectious disease spread inland by the transferring of merchandise through Justinian's efforts in acquiring luxurious goods of the time and exporting supplies, his capital became the leading exporter of the bubonic plague. Procopius, in his work Secret History, declared that Justinian was a demon of an emperor who either created the plague himself or was being punished for his sinfulness.The pandemic resulted in the deaths of an estimated 25 million (6th century outbreak) to 50
In the Late Middle Ages Europe experienced the deadliest disease outbreak in history when the Black Death, the infamous pandemic of bubonic plague, hit in 1347, killing a third of the European human population. Some historians believe that society subsequently became more violent as the mass mortality rate cheapened life and thus increased warfare, crime, popular revolt, waves of flagellants, and persecution.The Black Death originated in Central Asia and spread from Italy and then throughout other European countries. Arab historians Ibn Al-Wardni and Almaqrizi believed the Black Death originated in Mongolia. Chinese records also showed a huge outbreak in Mongolia in the early 1330s. Research published in 2002 suggests that it began in early 1346 in the steppe region, where a plague reservoir stretches from the northwestern shore of the Caspian Sea into southern Russia. The Mongols had cut off the trade route, the Silk Road, between China and Europe which halted the spread of the Black Death from eastern Russia to Western Europe. The epidemic began with an attack that Mongols launched on the Italian merchants' last trading station in the region, Caffa in the Crimea. In late 1346, plague broke out among the besiegers and from them penetrated into the town. The Mongol forces catapulted plague infected corpses into Caffa as a form of attack one of the first known instances of biological warfare When spring arrived, the Italian merchants fled on their ships, unknowingly carrying the Black Death. Carried by the fleas on rats, the plague initially spread to humans near the Black Sea and then outwards to the rest of Europe as a result of people fleeing from one area to another.
The plague resurfaced for a third time in the mid-19th century. Like the two previous outbreaks, this one also originated in Eastern Asia, most likely in Yunnan Province of China, where there are several natural plague foci.The initial outbreaks occurred in the second half of the eighteenth century. The disease remained localized in Southwest China for several years before spreading. In the city of Canton, beginning in January 1894, the disease killed 80,000 people by June. Daily water-traffic with the nearby city of Hong Kong rapidly spread the plague there, killing over 2,400 within two months.
Also known as the modern pandemic, the third pandemic spread the disease to port cities throughout the world in the second half of the 19th century and early 20th century via shipping routes.The plague infected people in Chinatown in San Francisco from 1900 to 1904, and in the nearby locales of Oakland and the East Bay again from 1907 to 1909. During the outbreak from 1900 to 1904 in San Francisco is when authorities made permanent the Chinese Exclusion Act. This law was originally signed into existence by President Chester A. Arthur in 1882. The Chinese Exclusion Act was supposed to last for ten years but was renewed in 1892 with the Geary Act and subsequently made permanent in 1902 during the outbreak of plague in Chinatown, San Francisco. The last major outbreak in the United States occurred in Los Angeles in 1924, though the disease is still present in wild rodents, and can be passed to humans that come in contact with them. According to the World Health Organization, the pandemic was considered active until 1959, when worldwide casualties dropped to 200 per year. In 1994, a plague outbreak in five Indian states caused an estimated 700 infections (including 52 deaths) and triggered a large migration of Indians within India as they tried to avoid the plague.
The scale of death and social upheaval associated with plague outbreaks has made the topic prominent in a number of historical and fictional accounts since the disease was first recognized. The Black Death in particular is described and referenced in numerous contemporary sources, some of which, including works by Chaucer, Boccaccio, and Petrarch, are considered part of the Western canon. The Decameron, by Boccaccio, is notable for its use of a frame story involving individuals who have fled Florence for a secluded villa to escape the Black Death. First-person, sometimes sensationalized or fictionalized, accounts of living through plague years have also been popular across centuries and cultures. For example, Samuel Pepys's diary makes a number of references to his first-hand experiences of the Great Plague of London in 1665–6.
Later works, such as Albert Camus's novel The Plague or Ingmar Bergman's film The Seventh Seal have used bubonic plague in settings, such as quarantined cities in either medieval or modern times, as a backdrop to explore a variety of concepts. Common themes include the breakdown of society, institutions, and individuals during the plague, the cultural and psychological existential confrontation with mortality, and the allegorical use of the plague in reference to contemporary moral or spiritual questions.[ citation needed ]
Some of the earliest instances of biological warfare were said to have been products of the plague, as armies of the 14th century were recorded catapulting diseased corpses over the walls of towns and villages to spread the pestilence. This was done by Jani Beg when he attacked the city of Kaffa in 1343.
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 Kiyoshi Kawashima, testified that, in 1941, 40 members of Unit 731 air-dropped plague-contaminated fleas on Changde. These operations caused epidemic plague outbreaks.
The Black Death was the deadliest pandemic recorded in human history. The Black Death resulted in the deaths of up to 25–200 million people in Eurasia and North Africa, peaking in Europe from 1347 to 1351. Plague, the disease caused by the bacterium Yersinia pestis, was the cause; Y. pestis infection most commonly results in bubonic plague, but can cause septicaemic or pneumonic plagues.
Plague is an infectious disease caused by the bacterium Yersinia pestis. Symptoms include fever, weakness and headache. Usually this begins one to seven days after exposure. In the bubonic form there is also swelling of lymph nodes, while in the septicemic form tissues may turn black and die, and in the pneumonic form shortness of breath, cough and chest pain may occur.
Yersinia pestis is a gram-negative, non-motile, rod-shaped, coccobacillus bacterium, with no spores. It is a facultative anaerobic organism that can infect humans via the Oriental rat flea. It causes the disease plague, which takes three main forms: pneumonic, septicemic, and bubonic.
Pneumonic plague is a severe lung infection caused by the bacterium Yersinia pestis. Symptoms include fever, headache, shortness of breath, chest pain, and cough. They typically start about three to seven days after exposure. It is one of three forms of plague, the other two being septicemic plague and bubonic plague.
Tularemia, also known as rabbit fever, is an infectious disease caused by the bacterium Francisella tularensis. Symptoms may include fever, skin ulcers, and enlarged lymph nodes. Occasionally, a form that results in pneumonia or a throat infection may occur.
Septicemic plague is one of the three main forms of plague. It is caused by Yersinia pestis, a gram-negative species of bacterium. Septicemic plague is a life-threatening infection of the blood, most commonly spread by bites from infected fleas.
The Plague of Justinian or Justinianic Plague was the beginning of the first plague pandemic, the first Old World pandemic of plague, the contagious disease caused by the bacterium Yersinia pestis. The disease afflicted the entire Mediterranean Basin, Europe, and the Near East, severely affecting the Sasanian Empire and the Roman Empire and especially its capital, Constantinople. The plague is named for the Roman emperor in Constantinople, Justinian I, who according to his court historian Procopius contracted the disease and recovered in 542, at the height of the epidemic which killed about a fifth of the population in the imperial capital. The contagion arrived in Roman Egypt in 541 and spread around the Mediterranean Sea until 544; in Northern Europe and the Arabian Peninsula it persisted until 549.
The third plague pandemic was a major bubonic plague pandemic that began in Yunnan, China, in 1855 during the fifth year of the Xianfeng Emperor of the Qing dynasty. This episode of bubonic plague spread to all inhabited continents, and ultimately led to more than 12 million deaths in India and China, with about 10 million killed in India alone. According to the World Health Organization, the pandemic was considered active until 1960, when worldwide casualties dropped to 200 per year. Plague deaths have continued at a lower level for every year since.
The Great Plague of Seville (1647–1652) was a massive outbreak of disease in Spain that killed up to a quarter of Seville's population.
Globalization, the flow of information, goods, capital, and people across political and geographic boundaries, allows infectious diseases to rapidly spread around the world, while also allowing the alleviation of factors such as hunger and poverty, which are key determinants of global health. The spread of diseases across wide geographic scales has increased through history. Early diseases that spread from Asia to Europe were bubonic plague, influenza of various types, and similar infectious diseases.
A bubo is adenitis or inflammation of the lymph nodes and is an example of reactive lymphadenopathy.
Theories of the Black Death are a variety of explanations that have been advanced to explain the nature and transmission of the Black Death (1347–51). A number of epidemiologists and since the 1980s have challenged the traditional view that the Black Death was caused by plague based on the type and spread of the disease. The confirmation in 2010 and 2011 that Yersinia pestis DNA was associated with a large number of plague sites has renewed focus on plague as the leading hypothesis, but has not yet led to a final resolution of all these questions.
The Black Death was a bubonic plague pandemic, which reached England in June 1348. It was the first and most severe manifestation of the Second Pandemic, caused by Yersinia pestis bacteria. The term "Black Death" was not used until the late 17th century.
The 1994 plague in India was an outbreak of bubonic and pneumonic plague in south-central and western India from 26 August to 18 October 1994. 693 suspected cases and 56 deaths were reported from the five affected Indian states as well as the Union Territory of Delhi. These cases were from Maharashtra, Gujarat, Karnataka, Uttar Pradesh, Madhya Pradesh and New Delhi. There are no reports of cases being exported to other countries.
The First Plague Pandemic was the first Old World pandemic of plague, the contagious disease caused by the bacterium Yersinia pestis. Also called the Early Medieval Pandemic, it began with the Plague of Justinian in 541 and continued until 750 or 767; at least fifteen or eighteen major waves of plague following the Justinianic plague have been identified from historical records. The pandemic affected the Mediterranean Basin most severely and most frequently, but also infected the Near East and Northern Europe. The Roman emperor Justinian I's name is sometimes applied to the whole series of plague epidemics in late Antiquity, as well as to the Plague of Justinian which struck the East Roman Empire in the early 540s.
Urban plague is an infectious disease among rodent species that live in close association with humans in urban areas. It is caused by the bacterium Yersinia pestis which is the same bacterium that causes bubonic and pneumonic plague in humans. Plague was first introduced into the United States in 1900 by rat–infested steamships that had sailed from affected areas, mostly from Asia. Urban plague spread from urban rats to rural rodent species, especially among prairie dogs in the western United States.
The 1924 Los Angeles pneumonic plague outbreak began October 30, 1924, and was declared fully contained on November 13, 1924. It represented the first time plague had emerged in Southern California; plague outbreaks had previously arisen in San Francisco and Oakland. The Los Angeles outbreak began on October 30, lasted two weeks, and killed 30 people. Public health officials credited the lessons learned from the San Francisco outbreak coupled with swiftly implemented measures, including hospitalization of the sick and all their contacts, a neighborhood quarantine, and a large-scale rat eradication program, with saving lives.
Madagascar has experienced several outbreaks of bubonic and pneumonic plague in the 21st century. In the outbreak beginning in 2014, 71 died; in 2017, 221 died. Smaller outbreaks occurred in January 2008, and December 2013.
Globally about 600 cases of plague are reported a year. In 2017 and November 2019 the countries with the most cases include the Democratic Republic of the Congo, Madagascar, and Peru.
The 1675–1676 Malta plague epidemic was a major outbreak of plague on the island of Malta, then ruled by the Order of St John. It occurred between December 1675 and August 1676, and it resulted in approximately 11,300 deaths, making it the deadliest epidemic in Maltese history. Most deaths were in the urban areas, including the capital Valletta and the Three Cities, and these had a mortality rate of about 41%. In the rural settlements, the mortality rate was 6.9%.
The great waves of plague that twice devastated Europe and changed the course of history had their origins in China, a team of medical geneticists reported Sunday, as did a third plague outbreak that struck less harmfully in the 19th century.
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