Bubonic Plague: Causes, Effects and Treatments

The bubonic plague is one among 3 plagues caused by the bacterium known as Yersinia pestis. Y. pestis is listed as a category A bioterrorism agent, historically being used to infect vast numbers of individuals in Japan and China in the late 19^th century-early 20^th century. Even though the plague isn’t seen often in present day, it remains clinically essential due to the fact that the natural bubonic plague foci are extensively disbursed all through the world. The bubonic plague prompted 3 primary outbreaks in human history, converting the course of medicine and modern-day treatments.

Yersinia Pestis is a gram-negative bacteria in the Enterobacteriacae family. Alexandre Yersin first isolated the bacteria in Hong Kong during the third pandemic. Y. pestis is a pathogen that developed from Yersinia pseudotuberculosis around 5,000-7,000 years ago (Yang, Beijing Institute of Microbiology and Epidemiology, 2018).

Y. pestis agitates the gut of an infected flea, causing it to regurgitate infected blood into the would of either a rodent or human host. Rodents have an innate immunity to the pathogen, but can carry the disease and infect human hosts through bite or by passing infected fleas to the human host. Y. pestis travels through the lymphatic system and congregates into a lymph node, causing it to become inflamed, painful, and swollen.

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There are three major types of plague that is caused by Y. pestis: bubonic, pneumonic, and septicemic. Y. pestis is not only transmitted via infected rodents/fleas, but also through respiratory droplets, contact/ingestion of uncooked, infected meats, and contact with infected domestic animals. Plague pharyngitis, meningitis, and endophthalmitis have been reported clinically, although it is uncommon (Yang, Beijing Institute of Microbiology and Epidemiology, 2018).

Patients that have contracted the bubonic plague will develop sudden onset fever, chills, headache, and weakness. Swollen, tender and painful lymph nodes are another very common symptom of the plague since the bacteria will multiply in the closest lymph node to where the bacteria entered the body. F not treated with the appropriate antibiotics, the bacteria will spread throughout the body, ultimately resulting in death. Signs and symptoms of the plague generally develop within two to seven days after acquiring the Y. pestis infection, though in some cases, symptoms may appear within the first 24 hours, especially if exposed to the pneumonic plague (Stöppler, MD, 2019).

The bubonic and septicemic plague are not often spread from contact with infected individuals due to the fact that transmission takes place when fleas feed on infected rodents and then bite human hosts. Transmission of pneumonic plague to another individual commonly calls for direct and close contact with an infected individual. Pneumonic plague, however,  is extremely contagious because infected individuals spread the micro organism through droplets of respiratory secretions (Stöppler, MD, 2019).

The diagnosis of plague is confirmed upon identifying Yersinia pestis organisms in a sample of blood or tissue from the infected patient. Diagnostic tests include culturing the organism, demonstrating the surface proteins of the bacteria, or identifying genetic material of the bacteria (Stöppler, MD, 2019).

Examples of antibiotics that may be used include ciprofloxacin (Cipro, Cipro XR, Proquin XR), streptomycin, gentamicin (Garamycin), and doxycycline (Vibramycin, Oracea, Adoxa, Atridox). Individuals diagnosed with the plague require additional treatment, such as oxygen, respiratory aid, and medications to maintain adequate blood pressure (Stöppler, MD, 2019).

The first great pandemic of bubonic plague came from 541 CE. Named after Justinian 1, the emperor over Rome at the time, spread inland from Ethiopia in Africa where Justinian’s common and luxurious good were being shipped from. Justinian himself became infected with the plague, but ultimately survived due to experimental treatments. He was known as the creator of the plague and became known as the main exporter of the bubonic plague. The focus of the Justinian pandemic was in Constantinople, some experts believing the number of deaths to be as his as 10,000 per day. The plague went on to kill over a third of the cities population in the fall of 541 CE.

In 1347, the black death pandemic swept through Europe, causing the second great plague in the 14^th-18^th centuries. The plague was brought to the Crimea from Asia by the Tartar armies of Khan Janibeg, and by 1348 it had reached Marseille, Paris and Germany, then Spain, England and continued through numerous Europeon countiries until 1350. At the time, it was not know as “the black death”, but as  “the pestilence” or “pestilentia”.

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In 1374 when another epidemic of the Black Death occurred in Europe, Venice. Victims were quickly quarentined from the healthy and the government prevented ships to dock. In 1377, ships that were suspected of carrying individuals infected with the plague were rerouted to another port far from the main cities where the individuals suspected of the sickness were forced to stay at the port for up to 30 days to see if they became ill and parished or whether they remained healthy. This was found to not be very effective and in 1403, individuals were quarentined in a hospital for 40 days.

A major outbreak of the pneumonic plague occurred in 1665-1666 in Europe. To identify houses of infected individuals, a cross was painted on the doors and on the windows and individuals were quarentined to their homes. Upwards of 7000 people were dying per day in London, resulting in 100,000 individuals losing their lives to the dreaded disease. The disease began to dwindle and eventually end after the great fire of London in 1666 that caused many buildings and houses to be destroyed. Rodents were disturbed as new buldings were being built, causing them to flee from the cities and the plague to die out.

The plague is presently considered to be one of the most critical bioterrorism threats (UPMC Center for Health Security, 2014, 2013). Y. pestis was developed as an aerosol weapon by several nations all through history. Aerosol dissemination of the bacteria might cause primary pneumonic plague within the exposed populace, an otherwise uncommon, highly lethal, and contagious form of plague. The plague has been the cause of three of the great pandemics of the modern-day era-in the mid-sixth century, the mid-14th century (thought to be known as the black death, although it has not been confirmed), and the early 20th century (UPMC Center for Health Security, 2014, 2013).

The earliest record of a biological weapon containing Y. pestis occurred in the 14^th century. A Tartar army attempted to concur current day Crimea, China and reportedly catapulted deceased bodies infected with the plague over the walls. Centuries later, Japan’s Unit 731 attempted to harbor plague as a biological weapon as well. In 1940, 7,643 Chinese individuals died as a result of General Ishii Shiro’s campaign to drop bombs filled with the Y. pestis bacterium over Central China. Unit 731 were released by the US in exchange for information when they were brough to trial for war crimes against China. The US capitalized on this information and created the US Biological Weapons Program at Ft. Detrick, MD.

The bubonic plague is recognized by public health specialists as a recurrent infectious disease. Concerns regarding the use of Y. pestis as a biological weapon have many factors, such as: there is an extensive availability of Y. pestis in microbe banks around the world, there is significant natural availability of the Y. pestis bacteria in endemic regions, and antibiotic resistant strains of Y. pestis exist in nature. Precise treatment recommendations following a biological attack with the plague will depend on numerous factors, which includes antibiotic susceptibility of the strain.

A vaccine for plague isn’t presently available for civilian use within the united states, although one exists (UPMC Center for Health Security, 2014, 2013). In a pre-exposure setting, the vaccine has had some success with preventing and/or lessening the severity of the bubonic plague. Both attenuated live vaccines and subunit vaccines that protect against the pneumonic plague are currently being developed as of 2013 (UPMC Center for Health Security, 2014, 2013).

References

• CDC. (2018, November 27). Symptoms. Retrieved October 5, 2019, from https://www.cdc.gov/plague/symptoms/index.html
• Frith, JMVH, J. (n.d.). The History of Plague – Part 1. The Three Great Pandemics. Retrieved October 5, 2019, from https://jmvh.org/article/the-history-of-plague-part-1-the-three-great-pandemics/
• Hale, Montana State University, K. (n.d.). Yersinia pestis as a biological weapon – Insects, Disease, and Histroy. Retrieved October 5, 2019, from http://www.montana.edu/historybug/yersiniaessays/hale.html
• Stöppler, MD, M. C. (2019, March 27). Plague Symptoms, Types, Treatment & history of the black death. Retrieved October 5, 2019, from https://www.medicinenet.com/plague_facts/article.htm#what_are_risk_factors_for_plague
• UPMC Center for Health Security, 2014. (2013, December 1). Yersinia pestis (plague). Retrieved October 5, 2019, from http://www.centerforhealthsecurity.org/our-work/publications/plague-fact-sheet
• Yang, Beijing Institute of Microbiology and Epidemiology, R. (2018, January 1). Plague: Recognition, Treatment, and prevention. Retrieved October 5, 2019, from https://jcm.asm.org/content/56/1/e01519-17