Bubonic plague (patient information)

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 * Associate Editor(s)-in-Chief:  Samuel A. Hom

Overview
Plague is a severe and potentially deadly bacterial infection.

What are the symptoms of Bubonic plague?
Bubonic plague symptoms appear suddenly, usually after 2 - 5 days of exposure to the bacteria. Symptoms include: Pneumonic plague symptoms appear suddenly, typically 2 - 3 days after exposure. They include: Septicemic plague may cause death even before its symptoms occur. Symptoms can include:
 * Chills
 * General ill feeling (malaise)
 * High fever
 * Muscle pain
 * Severe headache
 * Seizures
 * Smooth, painful lymph gland swelling called a bubo
 * Commonly found in the groin, but may occur in the armpits or neck, most often at the site of the initial infection (bite or scratch)
 * Pain may occur in the area before the swelling appears
 * Difficulty breathing
 * Frothy, bloody sputum
 * Severe cough
 * Abdominal pain
 * Bleeding due to blood clotting problems
 * Diarrhea
 * Fever
 * Low blood pressure
 * Nausea
 * Organ failure
 * Vomiting

What causes Bubonic plague?
Plague is caused by the organism Yersinia pestis. Rodents, such as rats, spread the disease to humans. People can get the plague when they are bitten by a flea that carries the plague bacteria from an infected rodent. In rare cases, you may get the disease when handling an infected animal. Certain forms of the plague can be spread from human to human. When someone with pneumonic plague coughs, microscopic droplets carrying the infection move through the air. Anyone who breathes in these particles may catch the disease. An epidemic may be started this way. In the Middle Ages, massive plague epidemics killed millions of people. Today, plague is rare in the United States, but has been known to occur in parts of California, Utah, Arizona, Nevada, and New Mexico. There three most common forms of plague are:
 * Bubonic plague -- an infection of the lymph nodes
 * Pneumonic plague -- an infection of the lungs
 * Septicemic plague -- an infection of the blood
 * The time between being infected and developing symptoms is typically 2 to 10 days, but may be as short as a few hours for pneumonic plague.

Who is at highest risk?
People can get the plague when they are bitten by a flea that carries the plague bacteria from an infected rodent. In rare cases, you may get the disease when handling an infected animal. Risk factors for plague include a recent flea bite and exposure to rodents, especially rabbits, squirrels, or prairie dogs, or scratches or bites from infected domestic cats.

Diagnosis
When any of the symptoms become apparent. A plague diagnosis can be done by doing laboratory tests on a sample of blood or sputum (saliva and discharge from respiratory passages) or on fluid from a lymph node.

When to seek urgent medical care?
Call your health care provider if you develop plague symptoms after exposure to fleas or rodents, especially if you live in or have visited an area where plague occurs.

Treatment options
People with the plague need immediate treatment. If treatment is not received within 24 hours of when the first symptoms occur, death may be unavoidable. Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague. Oxygen, intravenous fluids, and respiratory support usually are also needed. Patients with pneumonic plague are strictly isolated from other patients. People who have had contact with anyone infected by pneumonic plague are watched carefully and are given antibiotics as a preventive measure.

Diseases with similar symptoms

 * Asthma
 * effects of antibiotics
 * allergies
 * whooping cough

Where to find medical care for Bubonic plague?
Directions to Hospitals Treating Bubonic plague

What to expect (Outlook/Prognosis)?
Without treatment, about 50 - 90% of those with bubonic plague die. Almost all people with pneumonic plague die if not treated. Treatment reduces the death rate to 50%.

Possible complications
It can lead to pneumonia, spread of infection through blood to whole body(septicemia), shock and even death if left untreated

Prevention
Plague will probably continue to exist in its many localized geographic areas around the world, and plague outbreaks in wild rodent hosts will continue to occur. Attempts to eliminate wild rodent plague are costly and futile. Therefore, primary preventive measures are directed toward reducing the threat of infection in humans in high risk areas through three techniques -- environmental management, public health education, and preventive drug therapy.