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Plague

Synonym: "black death"
German: Pest

1 Definition

The plague is a highly contagious, notifiable infectious disease. It is caused by the Yersinia pestis bacterium.

2 History

In the 14th century the plaque caused the death of 25 million people in Europe. That number accounts for one quarter of the population of the time. The last widespread European plague epidemic occurred in the 17th century, causing comparable suffering.

At the time many different mixtures (i.e. treacle), now outdated and obscure, were developed in order to try to fight the plague. The cologne water is also from then.

3 Pathogen

The pathogen causing the plague was identified by the swiss scientist Alexander Yersin. It is a gram negative rod bacterium: Yersinia pestis (genus: Yersinia, family: enterobacteriaceae).

4 Epidemiology

The main reservoir for plague bacteria are rodents (i.e. mice, weasels, rabbits etc.). These animals live in symbiosis with ectoparasites such as ticks and fleas. In limited endemic regions in the southwest of the USA, middle and south America, Africa and Asia cases of the plague can still be encountered. In Germany very rarely the plague is imported because of traveling (medical history).

5 Transmission

Occurences of plague outbreaks in humans can happen when a rodent species is shrinking and the fleas, carrying the plague bacteria, are forced to finding new hosts. If the preferred new host are house rats, an epidemic can be caused.

6 Clinical presentation

The course of the plague depends of the type of manifestation that occurs. Most cases start with a sudden and severe onset of symptoms and then continue to progress. All types of manifestation without treatment will lead to the causal pathogens reaching the patients blood stream (plague sepsis). This gives rise to a severe and generalized infection of the entire organism.

Besides the severe courses, the plague can also manifest with mild clinical symptoms: The so-called abortive plague is a mild form of the plague with a mild course and symptoms only presenting blandly. Often there is only a slight fever and minor swelling of the lymph nodes; at most a plague-spot is forms.

Several types of the plague are distinguished as follows:

Within hours severe symptoms are developed, including high fever, pneumonia and bloody sputum.

  • Abortive plague: This is a mild form of the plague. Symptoms are only a slight fever and mild swelling of the lymph nodes. Antibodies are produced, which ensure a long lasting immunity against all forms of the disease.

7 Diagnostics

Initially a diagnosis can only be made by direct proof of the bacteria from pus from lymph nodes or sputum.

8 Therapy

The immediate administration of antibiotic agenst is essential. For therapy of the plague tetracycline is used in combination with sulfonamides, quinolones and cotrimoxazole as well as streptomycin and chloramphenicol.

9 Prophylaxis

In case of a proven infection quarantine of the patient is necessary. All people that might have been in contact with him and are in danger of infection should be treated with antibiotics.

An active vaccine is available. However there is currently no country that requires it for entry and also none of the health agencies recommend it.

10 Legal provisions

In Germany, §6 of the infection protection law categorizes the plague as a notifiable disease. Any suspected or proven infection, as well as deaths, must be reported (Doctor has to report independent of proof of pathogen).

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