Pneumonic plague | |
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A scanning electron micrograph depicting a mass of Yersinia pestis bacteria | |
Specialty | Infectious disease |
Symptoms | Fever, headache, shortness of breath, cough, hemoptysis [1] |
Usual onset | 3 to 7 days [2] |
Causes | Yersinia pestis [3] |
Risk factors | Rodents [3] |
Diagnostic method | Sputum testing [1] |
Treatment | Antibiotics [1] |
Prognosis | Invariably fatal when left untreated [4] |
Frequency | Rare [2] |
Pneumonic plague is a severe lung infection caused by the bacterium Yersinia pestis . [3] Symptoms include fever, headache, shortness of breath, chest pain, and coughing. [1] They typically start about three to seven days after exposure. [2] It is one of three forms of plague, the other two being septicemic plague and bubonic plague. [3]
The pneumonic form may occur following an initial bubonic or septicemic plague infection. [3] It may also result from breathing in airborne droplets from another person or animal infected with pneumonic plague. [1] The difference between the forms of plague is the location of infection; in pneumonic plague the infection is in the lungs, in bubonic plague the lymph nodes, and in septicemic plague within the blood. [3] Diagnosis is by testing the blood, sputum, or fluid from a lymph node. [1]
While vaccines are being developed, in most countries they are not yet commercially available. [1] [3] Prevention is by avoiding contact with infected rodents, people, or cats. [1] [3] It is recommended that those infected be isolated from others. [2] Treatment of pneumonic plague consists of antibiotics. [1]
Plague is present among rodents in Africa, the Americas, and Asia. [3] Pneumonic plague is more serious and less common than bubonic plague. [1] The total reported number of cases of all types of plague in 2013 was 783. [2] Left untreated, pneumonic plague is always fatal. [3] Some hypothesize that the pneumonic version of the plague was mainly responsible for the Black Death that resulted in approximately 75 - 200 million deaths in the 1300s. [2] [5]
The most apparent symptom of pneumonic plague is coughing, often with hemoptysis (coughing up blood). With pneumonic plague, the first signs of illness are fever, headache, weakness and rapidly developing pneumonia with shortness of breath, chest pain, cough and sometimes bloody or watery sputum. [6]
The pneumonia progresses for two to four days and may cause respiratory failure and shock. Patients will die without early treatment, some within 36 hours.[ citation needed ]
Initial pneumonic plague symptoms can often include the following:[ citation needed ]
Rapidly developing pneumonia with:[ citation needed ]
Pneumonic plague can be caused in two ways: primary, which results from the inhalation of aerosolized plague bacteria, or secondary, when septicemic plague spreads into lung tissue from the bloodstream. Pneumonic plague is not exclusively vector-borne like bubonic plague; instead, it can be spread from person to person. There have been cases of pneumonic plague resulting from the dissection or handling of contaminated animal tissue. This is one of the types of plague formerly known as the Black Death. [7]
Pneumonic plague is a very aggressive infection requiring early treatment, which must be given within 24 hours of first symptoms to reduce the risk of death. [6] Streptomycin, gentamicin, tetracyclines and chloramphenicol are all able to kill the causative bacterium.[ citation needed ]
Antibiotic treatment for seven days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection. [6]
The mortality rate from untreated pneumonic plague approaches 100%. [8]
Since 2002, the World Health Organization (WHO) has reported seven plague outbreaks, though some may go unreported because they often happen in remote areas. Between 1998 and 2009, nearly 24,000 cases have been reported, including about 2,000 deaths, in Africa, Asia, the Americas, and Eastern Europe. Ninety-eight percent of the world's cases occur in Africa.
Two outbreaks occurred in the Democratic Republic of the Congo in 2005 and 2006. [9] The outbreak in 2005 was only detected by looking back at blood samples. [9] The total death toll was 111.
In September 1994, India experienced an outbreak of plague that killed 50 and caused travel to New Delhi by air to be suspended until the outbreak was brought under control. [10] The outbreak was feared to be much worse because the plague superficially resembles other common diseases such as influenza and bronchitis; over 200 people that had been quarantined were released when they did not test positive for the plague. [11] All but two of the deaths occurred around the city of Surat.[ citation needed ]
A major outbreak of the pneumonic plague occurred in Manchuria from 1910 to 1911, in what became known as the Manchurian plague, killing around 60,000 people. [12] The Qing court dispatched Wu Lien-teh, a doctor educated at Cambridge University, to oversee disease control and treatment efforts. He made the novel observation that the disease was transmitted by air, and developed prototypical respirators to help prevent its spread. [13] A second, less deadly outbreak occurred in 1920–21, killing approximately 9,300 people. [12]
The People's Republic of China has eradicated pneumonic plague from most parts of the country, but still reports occasional cases in remote western areas, where the disease is carried by rats and the marmots that live across the Himalayan plateau. Outbreaks can be caused when a person eats an infected marmot or comes into contact with fleas carried by rats. A 2006 WHO report from an international meeting on plague cited a Chinese government disease expert as saying that most cases of the plague in China's northwest occur when hunters are contaminated while skinning infected animals. [14]
The expert said at the time that, due to the region's remoteness, the disease killed more than half the infected people. The report also said that since the 1990s, there was a rise in plague cases in humans—from fewer than 10 in the 1980s to nearly 100 cases in 1996 and 254 in 2000. [15] In September 2008, two people in East Tibet died of pneumonic plague. [16]
An outbreak of the disease in China began in August 2009 in Ziketan Town located in Qinghai Province. The town was sealed off and several people died as a result of the disease. [14] [17] According to spokesperson Vivian Tan of the WHO office in Beijing, "In cases like this [in August 2009], we encourage the authorities to identify cases, to investigate any suspicious symptoms among close contacts, and to treat confirmed cases as soon as possible. So far, they have done exactly that. There have been sporadic cases reported around the country in the last few years so the authorities do have the experience to deal with this." [18]
In September 2010, five cases of pneumonic plague were reported in Tibet. [19]
In July 2014, Chinese media reported one case found in Gansu. [20]
On 12 November 2019, It was announced that two people from the Chinese province of Inner Mongolia were diagnosed with pneumonic plague. They received treatment in Chaoyang District, Beijing, and authorities implemented preventative control measures. [21] Later in November, a third case of plague was confirmed. A 55-year-old man was diagnosed with bubonic plague after eating wild rabbit in Inner Mongolia. The region's health commission says it has no evidence to suggest that this case is linked to the previous two. [22] By the end of November, a fourth case was confirmed. Chinese health authorities reported a fresh case of bubonic plague in the country's northern Inner Mongolia region, bringing the total number of reported plague cases originating from Inner Mongolia to four. [23]
In August 2010, Peru's health minister Oscar Ugarte announced that an outbreak of plague had killed a 14-year-old boy and had infected at least 31 people in a northern coastal province. The boy died of bubonic plague on 26 July 2010. Ugarte stated that authorities were screening sugar and fish meal exports from Ascope Province, located about 325 miles (520 km) northwest of Lima, not far from the popular Chicama beach. Most of the infections in Peru were bubonic plague, with four cases of pneumonic plague. [24]
The first recorded plague outbreak in Peru was in 1903. Prior to the above case, the last known outbreak was in 1994, killing 35 people. [25]
In November 2013, an outbreak of plague occurred in the African island nation of Madagascar. [26] As of 16 December, at least 89 people were infected, with 39 deaths [27] with at least two cases involving pneumonic plague. However, as many as 90% of cases were later reported to have involved pneumonic plague. [28]
From 23 August to 30 September 2017, a total of 73 suspected, probable, and confirmed cases of pneumonic plague, including 17 deaths, were reported in Madagascar. [29] The diagnosis was confirmed by the Institut Pasteur de Madagascar by a polymerase chain reaction test, while field health workers used a Rapid Diagnostic Test. The WHO and Institut Pasteur de Madagascar were both involved in administering antibiotic compounds and attempting to stop the spread of the disease. By mid-October, there were an estimated 684 confirmed cases of plague with 474 pneumonic, 156 bubonic and one septicemic. The remainder were not classified. At least 74 deaths have been ascribed to pneumonic plague. [30]
The outbreak officially ended on 26 November 2017 with 2,348 cases and 202 deaths officially reported. [31]
In the fall of 1924, an outbreak occurred in Los Angeles [32] that killed 30 people.
On 2 November 2007, wildlife biologist Eric York died of pneumonic plague in Grand Canyon National Park. York was exposed to the bacteria while conducting a necropsy on a cougar carcass. [33]
In 2014, the Colorado Department of Public Health and Environment confirmed that a Colorado man had been diagnosed with pneumonic plague, the first confirmed human case in Colorado in more than 10 years, and one of only 60 cases since 1957. The man was found to have the disease after the family dog died unexpectedly and a necropsy revealed that the disease was the cause. [34] [35] Three additional pneumonic plague cases were confirmed in Colorado before the outbreak ended. [36]
The Black Death was a bubonic plague pandemic occurring in Europe from 1346 to 1353. It was one of the most fatal pandemics in human history; as many as 50 million people perished, perhaps 50% of Europe's 14th century population. The disease is caused by the bacterium Yersinia pestis and spread by fleas and through the air. One of the most significant events in European history, the Black Death had far-reaching population, economic, and cultural impacts. It was the beginning of the second plague pandemic. The plague created religious, social and economic upheavals, with profound effects on the course of European history.
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. There are three forms of plague, each affecting a different part of the body and causing associated symptoms. Pneumonic plague infects the lungs, causing shortness of breath, coughing and chest pain; bubonic plague affects the lymph nodes, making them swell; and septicemic plague infects the blood and can cause tissues to turn black and die.
Yersinia pestis is a gram-negative, non-motile, coccobacillus bacterium without spores that is related to both Yersinia enterocolitica and Yersinia pseudotuberculosis, the pathogen from which Y. pestis evolved and responsible for the Far East scarlet-like fever. It is a facultative anaerobic organism that can infect humans via the Oriental rat flea. It causes the disease plague, which caused the Plague of Justinian and the Black Death, the deadliest pandemic in recorded history. Plague takes three main forms: pneumonic, septicemic, and bubonic. Yersinia pestis is a parasite of its host, the rat flea, which is also a parasite of rats, hence Y. pestis is a hyperparasite.
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 forms of plague, and is caused by Yersinia pestis, a gram-negative species of bacterium. Septicemic plague is a systemic disease involving infection of the blood and is most commonly spread by bites from infected fleas. Septicemic plague can cause disseminated intravascular coagulation and is always fatal when untreated. The other varieties of the plague are bubonic plague and pneumonic plague.
The third plague pandemic was a major bubonic plague pandemic that began in Yunnan, China, in 1855. This episode of bubonic plague spread to all inhabited continents, and ultimately led to more than 12 million deaths in India and China, and at least 10 million Indians were killed in British Raj India alone, making it one of the deadliest pandemics in history. 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.
Canine influenza is influenza occurring in canine animals. Canine influenza is caused by varieties of influenzavirus A, such as equine influenza virus H3N8, which was discovered to cause disease in canines in 2004. Because of the lack of previous exposure to this virus, dogs have no natural immunity to it. Therefore, the disease is rapidly transmitted between individual dogs. Canine influenza may be endemic in some regional dog populations of the United States. It is a disease with a high morbidity but a low incidence of death.
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.
Bubonic plague is one of three types of plague caused by the bacterium Yersinia pestis. One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting, as well as swollen and painful lymph nodes occurring in the area closest to where the bacteria entered the skin. Acral necrosis, the dark discoloration of skin, is another symptom. Occasionally, swollen lymph nodes, known as "buboes", may break open.
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 from the 1980s to the 2000s 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 led researchers to conclude that "Finally, plague is plague."
Zigortang Town, Zigongtang Town, or Ziketan Town is a farming town in Xinghai County of Hainan Tibetan Autonomous Prefecture, Qinghai province, People's Republic of China. Zigortang town covers approximately 3,000 square kilometres (1,158 sq mi) and has a population of 10,000.
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 San Francisco plague of 1900–1904 was an epidemic of bubonic plague centered on San Francisco's Chinatown. It was the first plague epidemic in the continental United States. The epidemic was recognized by medical authorities in March 1900, but its existence was denied for more than two years by California's Governor Henry Gage. His denial was based on business reasons, to protect the reputations of San Francisco and California and to prevent the loss of revenue due to quarantine. The failure to act quickly may have allowed the disease to establish itself among local animal populations. Federal authorities worked to prove that there was a major health problem, and they isolated the affected area; this undermined Gage's credibility, and he lost the governorship in the 1902 elections. The new governor, George Pardee, implemented public-health measures and the epidemic was stopped in 1904. There were 121 cases identified, resulting in 119 deaths.
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 was an outbreak of the pneumonic plague in Los Angeles, California that began on September 28, 1924, and was declared fully contained on November 13, 1924. It represented the first time that the plague had emerged in Southern California since plague outbreaks had previously surfaced in San Francisco and Oakland. The suspected reason for this outbreak was a rat epizootic where squirrels that were found to be plague infected were secondarily infected by rats. Due to the evidence of infected squirrels near San Luis Obispo County as late as July 1924 and the migration habits of both squirrels and rats, it is thought that squirrels were the original source of the plague outbreak in Los Angeles.
A feline zoonosis is a viral, bacterial, fungal, protozoan, nematode or arthropod infection that can be transmitted to humans from the domesticated cat, Felis catus. Some of these diseases are reemerging and newly emerging infections or infestations caused by zoonotic pathogens transmitted by cats. In some instances, the cat can display symptoms of infection and sometimes the cat remains asymptomatic. There can be serious illnesses and clinical manifestations in people who become infected. This is dependent on the immune status and age of the person. Those who live in close association with cats are more prone to these infections, but those that do not keep cats as pets can also acquire these infections as the transmission can be from cat feces and the parasites that leave their bodies.
Madagascar has experienced several outbreaks of bubonic and pneumonic plague in the 21st century. In the outbreak beginning in 2014, 71 died; in 2017, 202 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 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, which had a mortality rate of about 41%. In the rural settlements, the mortality rate was 6.9%.
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