Black Death

Plague, bubonic plague, pneumonic plague, or septicemic plague

Plague is an infection transmitted from rodents to humans by fleas. An infected flea bites a human, transmitting the disease. This disease can also be transmitted by accidentally ingesting flea feces or can be transmitted from someone with plague Pneumonia (lung infection) via coughing, thereby passing Plague bacteria to another person.

The disease is present in third world countries and is endemic (i.e., present at all times) in the S.W., USA (the general area of California, Nevada, Arizona, Utah). Plague is rare in areas with good sanitation and rodent population control.

Symptoms appear 2-10 days after exposure to Bubonic plague
BP (Bubonic Plague):

High Fever
Chills
Headache
Weakness
Muscle aches
Joint aches
Poor appetite
There may be reddened areas, pus, fluid-filled sacs (Vesicles), or burn-like slough (eschar) where the flea bite occurred.
Buboes (enlarged lymph nodes in the groin, armpits, neck, and other sites).
Buboes can get as large as eggs.
Black-purple spots can appear under the skin.

SP (septicemic Plague):

Symptoms of BP (can occur without BP symptoms)
Seizures
Shock
Confusion
Bleeding tendency

PP (pneumonic plaque):

With BP or SP

Symptoms occur within hours -- one day after inhalation of bacteria

Cough

Frothy sputum (what is coughed up)

Coughing blood

Chest pain

Shortness of breath

Confusion.

Bluish tinge to skin and lips (cyanosis)

Shock

Death

Bacteria -- Yersinia pestis causes the so-calledBubonic Plague (BP), which is characterized by buboes, swollen lumps that are reddened, smooth, painful, and tender. These lumps are swollen lymph nodes that act as a filter to keep bacteria and other invaders out of the blood stream.

The bacteria can spread to the blood (septicemic Plague, SP). The bacteria can be inhaled into the lungs and cause Pneumonic Plague, PP.

Infected cats can also transmit the bacteria by scratching or biting humans.

History of exposure
Medical evaluation:

Physical signs of infection (e.g., buboes)Low Blood Pressure
High fever
Rapid heart rate
Rapid breathing
Bluish lips and skin
Swollen lymph nodes
Liver and spleen may be enlarged.

Tests:

Blood, urine, sputum, and fluid from buboes or other lesions are collected and sent immediately to a laboratory where the bacteria are grown and identified (cultures).

The secretions from buboes, sputum, and blood can also be stained with a dye (gram stain). When examined under a microscope, it will show the bacteria of Y. pestis.

Blood samples will show an elevation of the number of white blood cells (body's soldiers) low number of platelets (cells that stop bleeding), and low oxygen levels.

Biopsy or sample of the buboes will show the bacteria.

Chest X-Ray will show patchy areas in the lungs in PP.

Echocardiography uses sound waves to generate a picture to show fluid around the heart (seropurulent Pericarditis).

Spinal fluid is removed (spinal tap) if spread of infection to the membranes covering the brain is suspected.

Public health authorities will need to be notified if a diagnosis of the Plague is confirmed.

Third world countries where rodent population is out of control

Skinning wild animals

Workers in laboratories where Y. pestis is grown

Healthcare workers taking care of patients with pneumonic Plague

War zones

Famine

Admit to hospital.

Isolate from other patients for 48 hours after effective therapy is started or cultures are negative.

Gloves must be worn at all times when in contact with the infected individual.

Avoid contact with all bodily fluids (urine, sputum, saliva, blood, and semen).

Fluids are given intravenously -- IV (via the veins)

Oxygen may be needed.

If in Shock or having Seizures, appropriate medications are given.

Antibiotics IV such as streptomycin or gentamicin are given.

Rarely, if patient is not too sick, antibiotics such as tetracycline can be used.

If the heart stops or the patient cannot breathe (or stops breathing), start CPR and put him on a respirator (breathing machine) immediately. The persons performing CPR must protect their own airways.

Plague spreads very rapidly and can be fatal. The general public should avoid all contact with infected rodents and patients. Immediate treatment and notification of authorities is a must. The faster one gets treatment, the better the chances of survival.