Bubonic plague

Bubonic plague
Plague -buboes.jpg
A bubo on the upper thigh of a person infected with bubonic plague.
SpecialtyInfectious disease
SymptomsFever, headaches, vomiting, swollen lymph nodes[1][2]
Usual onset1–7 days after exposure[1]
CausesYersinia pestis spread by fleas[1]
Diagnostic methodFinding the bacteria in the blood, sputum, or lymph nodes[1]
TreatmentAntibiotics such as streptomycin, gentamicin, or doxycycline[3][4]
Frequency650 cases reported a year[1]
Deaths10% mortality with treatment[3]

Bubonic plague is one of three types of plague caused by bacterium Yersinia pestis.[1] One to seven days after exposure to the bacteria, flu-like symptoms develop.[1] These symptoms include fever, headaches, and vomiting.[1] Swollen and painful lymph nodes occur in the area closest to where the bacteria entered the skin.[2] Occasionally, the swollen lymph nodes may break open.[1]

The three types of plague are the result of the route of infection: bubonic plague, septicemic plague, and pneumonic plague.[1] Bubonic plague is mainly spread by infected fleas from small animals.[1] It may also result from exposure to the body fluids from a dead plague-infected animal.[5] 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.[1] Diagnosis is made by finding the bacteria in the blood, sputum, or fluid from lymph nodes.[1]

Prevention is through public health measures such as not handling dead animals in areas where plague is common.[1] Vaccines have not been found to be very useful for plague prevention.[1] Several antibiotics are effective for treatment, including streptomycin, gentamicin, and doxycycline.[3][4] Without treatment, plague results in the death of 30% to 90% of those infected.[1][3] Death, if it occurs, is typically within ten days.[6] With treatment the risk of death is around 10%.[3] Globally there are about 650 documented cases a year, which result in ~120 deaths.[1] In the 21st century, the disease is most common in Africa.[1]

The plague is believed to be the cause of the Black Death that swept through Asia, Europe, and Africa in the 14th century and killed an estimated 50 million people.[1] This was about 25% to 60% of the European population.[1][7] Because the plague killed so many of the working population, wages rose due to the demand for labor.[7] Some historians see this as a turning point in European economic development.[7] 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.[8] The term bubonic is derived from the Greek word βουβών, meaning "groin".[9] The term "buboes" is also used to refer to the swollen lymph nodes.[10]

Signs and symptoms

Necrosis of the nose, the lips, and the fingers and residual bruising over both forearms in a person recovering from bubonic plague that disseminated to the blood and the lungs. At one time, the person's entire body was bruised.

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. Acral gangrene (i.e., of the fingers, toes, lips and nose) is another common symptom.

Because of its bite-based mode of transmission, the bubonic plague is often the first of a progressive series of illnesses. Bubonic plague symptoms appear suddenly a few days after exposure to the bacterium. Symptoms include:

  • Chills
  • General ill feeling (malaise)
  • High fever >39 °C (102.2 °F)
  • Muscle cramps[11]
  • Seizures
  • Smooth, painful lymph gland swelling called a bubo, commonly found in the groin, but may occur in the armpits or neck, most often near the site of the initial infection (bite or scratch)
  • Pain may occur in the area before the swelling appears
  • Gangrene of the extremities such as toes, fingers, lips and tip of the nose.[12]

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, and coma.