Contagious plague is among the most serious bacterial infections. Plague, a highly dangerous disease, is not only contagious but can also be fatal. The disease caused by the bacteria named Yersinia pestis is also known as the “black plague” among the people. Yersinia pestis bacteria are generally found in animals and are most commonly transmitted to humans through fleas. Although researches show that plague is more common in rural settlements, it can easily spread from these regions to cities because of its contagious nature.
The high population of mice in distorted urban settlements due to insufficient infrastructure and improper hygiene conditions may pave the way for the faster spread of it. Since the disease is a bacterial disease, it is possible to prevent the disease with the antibiotics used today. It is seen that this disease, which has caused great epidemics and countless deaths in the past, has recently begun to disappear with the development and widespread of antibiotics.
What is the Plague?
İt is a zoonotic (transmitted from animals to humans) infectious disease. The syndromes in humans are mainly expressed as bubonic, septicemic, and pneumonic. The bacterium underlying all these syndromes is a bacterium called Yersinia pestis. The bacterium named Yersinia pestis, which is the cause of that disease was discovered as a result of various studies carried out by Alexandre Yersin in 1894 and took its name from its explorer. This bacterium has a thick and short structure called bacillus and can reproduce fairly easily. It has the ability to maintain its vitality for years in dark and humid environments, even outside the body. It is known that the bacterium can survive for weeks by transforming into a special form, for up to a month in the stool of fleas, and for a few weeks in inflammation and sputum. Yersinia Pestis bacteria, known to be extremely resistant to cold, can maintain their viability for very long periods in frozen environments. Although the transmission of this bacteria, which normally infects animals, to humans is entirely due to coincidental reasons, it has become one of the most important microorganisms in human history. This bacterium, which has been reported to have inflicted pandemics three times in written sources, has been described as “black death” especially in 14th century Europe and caused approximately one-third of the continent’s population to die. The first known documents of plague epidemics date back to the 6th century when the Roman emperor Justinian ruled in the Mediterranean Region. His latest pandemic started in Asia and India towards the end of the 19th century and then progressed to the African continent. Apart from this situation, Asia and the Americas, in general, have not yet met this bacterium, so plague is considered a potential bioterrorism threat. In the current period, 1000-2000 cases of plague are reported every year around the world. The region with the highest numbers in Africa.
Nowadays, after the diagnosis of the disease, it can be treated with 100% antibiotic applications. For this reason, it is very important to detect the symptoms in the early period in terms of success in the treatment of the disease. Individuals who experience symptoms related to plague disease should be treated by applying to health institutions as soon as possible.
What are the Types of Plague?
There are several different types of plague such as “Bubonic Plague”, “Septicemic Plague”, “Pulmonary (Pneumonic) Plague” and “Gastrointestinal Plague”. Bubonic plague, the most common type of plague, accounts for approximately 75% of all plague cases. The disease usually occurs after direct contact with infected rodents or fleas. In some rare cases, contact with the objects touched by the person with the plague may also be sufficient for the contamination of the bacteria. Bubonic plague is a disease that affects the lymphatic system, which is part of the immune system. A few days after the flea bite, redness and swelling of the lymph nodes can be observed in the bitten area. Within a few days, an inflamed fluid begins to emerge from the swollen lymph nodes due to infection. If the disease is not treated at this stage, the bacteria may spread to other parts of the body, resulting in a much more severe septicemic plague or lung plague.
One of the organs most affected by the plague is the lung, and when the bacteria reach the lungs, a type of plague called “Lung (Pneumonic) Plague” occurs. At this stage, the disease has reached the deadliest level. Its contagiousness is much higher than other types of plague. If the disease is not treated at this stage, the respiratory tract will be damaged and this can cause sudden death. Since the bacteria are in the lungs, they can easily be transmitted to other people by coughing and sneezing and can turn into an epidemic. The only type of plague that can be transmitted from person to person is the pneumonic plague.
“Gastrointestinal Plague” shows the same symptoms as other types of plague and should be diagnosed and treated like other species. Care should be taken as it can lead to death if left untreated.
“Septicemic Plague” disease occurs with the proliferation of Yersinia Pestis bacteria in the bloodstream. Since this type of plague spreads very quickly in the body with blood circulation, it can pose a threat to all organs. The most important feature of this type of plague is that it spreads directly through the bloodstream. Unlike other species, but on formation is not observed in septicemic plague cases, but the disease manifests itself with cracks in the skin, diarrhea, vomiting, and bleeding in the internal organs.
What are the Symptoms of the Plague?
The symptoms of that occur within 2-6 days after exposure to the causative bacteria. Symptoms may vary depending on the type of exposure and the type of plague that occurs. The period when the bacteria begin to reproduce in the body after entering the body is called the incubation period. The incubation period of this bacterium is very short, and its duration varies between 1-3 days, especially in airborne contacts.
Since the disease is of more than one type, the symptoms are also quite varied. In addition to high fever, head, waist, and leg pains, rashes due to flea bites are among the symptoms of the type of It called “Bubonic Plague.” Swollen painful lymph nodes are called bourbon. the symptom also gave this type of plague its name: Swollen (edematous) lymph nodes usually reach the size of an egg and can be sensitized by touch.
In addition, in the type of plague called “Septicemic Plague”, important symptoms such as tremor, weight loss, disturbance of bowel order, vomiting, high fever, blood flow from the mouth and nose, darkening caused by the death of tissues (necrosis and gangrene) and internal bleeding may occur. The most common areas where darkening is detected are fingers and toes and the nose area.
Coughing, difficulty in breathing, shock, blood in sputum, change in face color, chest pain, general weakness, and a feeling of extreme thirst indicate the type of plague called “Pulmonary Plague”. In this type of plague, also known as pneumonic plague, respiratory failure and shock may occur within 2 days after the development of infection. This type of plague can have a fatal course if there is no treatment within the first day after the symptoms occur.
High fever and bleeding from internal organs are among the common symptoms of all types of it. Since Yersinia Pestis bacteria cause inflammation in the body, it causes high fever. However, since the bacteria also damage internal organs, it can trigger serious problems such as internal bleeding in patients. Involuntary bleeding that occurs in certain parts of the body together with high fever must be taken seriously and a specialist should be consulted. Again, swelling in the lymph nodes is among the important symptoms of the disease.
What are the Causes of Plague?
The type of bacteria called Yersinia Pestis that causes plague is a microorganism that tends to infect wild rodents. Fleas, which are parasitic in a variety of wild animals such as mice, squirrels, rabbits, and field mice, can pave the way for the spread of the bacteria when fed on the blood of the infected animal. It can also be said that these fleas act as a mediator (vector) between wild animals and humans for the bacteria that cause it. Mice are the most common host animal for this bacterial species. Naturally, the most effective vector is detected as mouse fleas.
The most prominent risk factor for plague disease is contact with the host or vector organism in an area where the disease is active. In pneumonic plague, on the other hand, the human-to-human transmission may occur through droplets. If domestic creatures such as cats are infected with this bacteria, it may trigger the spread of the disease by scratching or biting people. The disease is usually detected in hot climates.
How Is Plague Diagnosed?
Since the symptoms of the disease are quite high, the patient should be evaluated from many angles during the diagnosis phase. If symptoms of plague are observed in the individual, some tests can be applied in the laboratory environment. Since the incubation period of the bacteria is between 2-8 days, blood tests are very important at this stage. In addition, lymph node biopsy is another diagnostic tool, as bacteria can directly affect lymph nodes. Before starting these procedures, it is important to take a detailed history of the patient. In the diagnostic approach to plague, it is necessary to suspect this disease first and various questions are asked by the physicians about the plague-related factors such as whether the person has made any travel to risky areas or the region he lives in. Following the medical history, physicians apply to various examinations to reveal the presence of plague bacteria in the body:
- Blood tests for septicemic plague
- Taking samples from swollen lymph nodes with a needle for bubonic plague
- Taking samples from the respiratory tract by advancing through the mouth or nose through bronchoscopy for pneumonic plague
The samples taken are sent to the laboratory for examination. Estimated results may occur within two hours, while final results may take 1-2 days. Due to the length of this period and its vital importance for the patient, physicians should start treatment for the plague as soon as they suspect this disease. The source of suspicion may vary depending on the type and symptoms of plague. Patients who stated that they had increased fever especially after visiting an endemic area and contact with a suspected rodent, people with symptoms such as fever and hypotension accompanying unexplained lymph node inflammation, cases such as blood sputum in pneumonia patient, and detection of bacteria in their lungs as a gram-negative bacillus, It should show a warning feature for physicians to think about the possibility of plague. Antibiotic treatment, which is initiated without waiting for the confirmation of the diagnosis, can be life-saving and has a shortening effect by stopping the progression of the disease.
The disease can also cause some changes in complete blood count tests. While the number of white blood cells per cubic millimeter is detected in the blood results of the person infected with the Y pestis bacteria, this parameter is usually accompanied by a decrease in the platelet count.
What Are Plague Treatment Methods?
İt is a life-threatening condition that requires immediate medical attention. Bubonic plague can leak into the bloodstream in a short time and result in the development of septicemia or lung in people who do not have access to appropriate treatment. In these cases, the death of the person after the first symptom may occur in as little as 24 hours. Isolation of people suspected of lung (pneumonic) plague from other patients is very important to prevent spread. At the same time, all healthcare professionals involved in the treatment of the patient should take all kinds of precautions for general and droplet contamination. Treatment continues for several weeks after the fever has been reduced. Anyone suspected of being in contact with pneumonic plague can be kept under observation and antibiotic treatment can be initiated as a precaution.
The most important point in increasing the success rate in the treatment of the disease is early diagnosis. The early diagnosed disease can be cured almost 100%. There is no need for any surgical intervention in the disease, which is completely treated with pharmacological methods. After the bacteria are detected in the body, drug therapy should be started quickly. If it is late to start medication, the disease progresses much faster. This situation prolongs and makes the treatment process difficult. Disease types are generally among the diseases with poor prognosis. People with bubonic plague will die with a 50-90% probability if appropriate antibiotic treatment is not given. The mortality rate in septicemic plague is slightly lower, which is considered to be approximately 22%. With the early diagnosis of diseases, a 5-15% reduction in the risk of death is achieved. Today, the lethality rate of It has decreased to 7%. It should be kept in mind that if the treatment is not started on the first day in pneumonic plague cases, it may progress very slowly and cause the person to die. Even if appropriate treatment is given in pneumonic plague, the risk of death is over 50%.
Because it is a bacterial disease and is caused by a single bacterial species, various powerful antibiotics are used in the treatment of plague. A suitable type of antibiotic-containing active ingredients such as streptomycin, gentamicin, doxycycline, ciprofloxacin, and chloramphenicol may be preferred for the treatment of the disease. In the first-line treatment of the disease, aminoglycoside-derived antibiotic drugs with active ingredients gentamicin and streptomycin are used. Antibiotic treatment is very effective in the treatment of the disease, and most patients respond to treatment within 1-2 weeks. There are 17 different vaccine studies currently underway for it. Being conscious and taking precautions are very important issues to prevent this fatal disease since none of them have been approved yet. Before visiting the regions where this disease is endemic, such as Africa, T.C. It is recommended to examine the recommended vaccines and drugs from the “travel health” website of the Ministry of Health or to get information about the health conditions of the country. In addition, activities such as avoiding contact with suspicious animals in areas endemic for plague, carrying out regular flea cleaning of the pet, not allowing the pet to roam free in that area, regularly using flea and insect repellent sprays in areas where the plague was seen before, and camping in areas close to rodent nests. Practices such as avoidance are among the steps that can be taken to avoid the plague.
If you also have symptoms of plague, you can apply to a healthcare institution in detail and have the necessary diagnostic tests done as soon as possible. Since early diagnosis is very important in plague disease and all other infectious diseases, you can start your treatment process as soon as possible and overcome the disease completely, prevent the disease from infecting your relatives and causing permanent damage to your body.
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