It was in the 14th century when almost all of Europe was ravaged by a curse that killed and inflicted millions of people. It travelled to Egypt, Turkey and China that devastated lives and brought down dynasties. It was, the Black Death. After researches and comparative studies, the cause of the Black Death has been associated to the occurrence of bubonic plagues (other infections include septicemic and pneumonic plagues). Bubonic plague has been related to the disease among fleas and rodents which had eventually inflicted humans as well. It is caused by a bacteria, Yersinia pestis from family Enterobacteriaceae, infecting humans through a flea bite.
- Swollen lymph nodes (called buboes) usually found in armpits, groin or neck area (classic sign)
- Body malaise
- Muscle cramps
The flea causing this disease is commonly found on rats, mice and other rodents. When this flea is infected, it attacks the rodent host until it dies. The bacteria attack the flea’s GI tract causing them to regurgitate ingested substances. Once it attacks humans through a bite, the blood ingested by the flea gets into their gut and gets infected. This blood is then regurgitated and left on the bite site. As the bacteria gets inside the host, it rapidly spreads and specifically attacks the lymph nodes. This bacteria can resist phagocytosis and can even destroy them. Therefore, their spread can be rapid and can lead do lymphatic hemmorhage. As it progresses, it causes the lymph nodes to swell and eventually necrotize.
To verify and diagnose a bubonic plague, various laboratory tests should be performed:
- Yersinia pestis culture (a sample is taken from a patient; this confirms the presence of the plague)
- Rapid Dipstick Test (confirms presence of Yersinia pestis antigen in patients)
- Serum Examination (this verifies presence of infection)
Antibiotic therapy is the management of choice to treat bubonic plague. Since antibiotic use significantly decreased the rate mortality among plague patients, it is recommended that treatment should be started as early as the first occurrence of symptom and should be complied as indicated. Antibiotics such as doxycycline, streptomycin, gentamicin, or ciprofloxacin are used. It is recommended that treatment should be initiated within the first 24 hours after the first symptom appeared; this greatly decreases the possibility of complication and mortality. Respiratory support may be necessary on the course of treatment coupled with intravenous support. In case of exposure and contact with infected individuals, prophylactic treatment is indicated.