Yersinia pestis infection overview: Difference between revisions
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{{Yersinia pestis infection}} | {{Yersinia pestis infection}} | ||
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==Overview== | ==Overview== | ||
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==Historical Perspective== | ==Historical Perspective== | ||
It is suggested that [[ | It is suggested that [[Yersinia pestis infection]] was a contributing factor in some of (though possibly not all) the European plagues. The earliest account describing a possible plague [[epidemic]] is found in I Samuel 5:6 of the Hebrew Bible (Tanakh). In this account, the Philistines of Ashdod were stricken with a plague for the crime of stealing the Ark of the Covenant from the Children of Israel. These events have been dated to approximately the second half of the 11th century BC. | ||
==Classification== | |||
The classification of plague depends on the mode of [[infection]] and the clinical [[syndrome]]. Plague can be classified into bubonic plague, septicemic plague, or pneumonic plague. | |||
==Pathophysiology== | ==Pathophysiology== | ||
[[Plague]] can be transmitted from flea bites or the inhalation of aerosol from an individual who has [[plague]] [[pneumonia]]. [[Pathogenesis]] due to the ''[[Yersinia pestis]]'' infection of mammalian hosts, results from several factors including the bacteria's avoidance of normal [[immune system]] responses, such as [[phagocytosis]] and [[antibody]] production. | |||
==Causes== | ==Causes== | ||
[[Yersinia pestis]], a rod-shaped [[facultative anaerobe]] with bipolar staining (giving it a safety pin appearance)<ref name=Baron>{{cite book | author = Collins FM | title = Pasteurella, Yersinia, and Francisella. ''In:'' Baron's Medical Microbiology ''(Baron S ''et al'', eds.)| edition = 4th | publisher = Univ. of Texas Medical Branch | year = 1996 | url = http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1611 | isbn = 0-9631172-1-1 }}</ref> | ''[[Yersinia pestis]]'' (''Y. pestis''), a rod-shaped [[facultative anaerobe]] with bipolar staining (giving it a safety pin appearance) causes the infection in mammals and humans.<ref name=Baron>{{cite book | author = Collins FM | title = Pasteurella, Yersinia, and Francisella. ''In:'' Baron's Medical Microbiology ''(Baron S ''et al'', eds.)| edition = 4th | publisher = Univ. of Texas Medical Branch | year = 1996 | url = http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1611 | isbn = 0-9631172-1-1 }}</ref> The bacteria maintain their existence in a cycle involving rodents and their fleas. The genus Yersinia is [[gram-negative]], bipolar staining coccobacilli, and, similarly to other [[Enterobacteriaceae]], it has a fermentative metabolism. ''Y. pestis'' produces an antiphagocytic slime. The organism is motile when isolated, but becomes nonmotile in the mammalian host. | ||
==Differential Diagnosis== | |||
The differential diagnosis for ''yersina pestis'' infection is dependent on the clinical syndrome (bubonic plague, septicimic plague, pneumonic plague, or pharyngeal plague). Bubonic plague should be differentiated from other causes of [[lymphadenopathy]], such as [[streptococcus|streptococcal]] or [[staphylococcus|staphylococcal]] [[lymphadenitis]], [[infectious mononucleosis]], [[cat-scratch fever]], and [[tularemia]]. Septicemic plague should be differentiated from non-specific [[sepsis]] syndrome and [[gram negative]] sepsis. The differential diagnosis for pneumonic plague includes infections that cause [[community-acquired pneumonia]], such as [[pneumococcus|pneumococcal]] or [[streptococcus|streptococcal]] pneumonia, [[virus|viral]] pneumonia, [[hemophilus influenzae]], and [[anthrax]].<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response and Control. WHO/CDS/CSR/EDC/99.2 </ref> | |||
==Risk Factors== | ==Risk Factors== | ||
Revision as of 00:11, 26 July 2014
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Yersinia pestis infection Microchapters |
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Differentiating Yersinia Pestis Infection from other Diseases |
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Yersinia pestis infection overview On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Esther Lee, M.A.
Overview
Yersinia pestis infection, an infectious disease of animals and humans, is caused by Yersinia pestis, a bacterium. Human yersinia pestis infection takes three main clinical forms: pneumonic, septicemic, and the bubonic plague. All three forms are widely believed to have been responsible for a number of high-mortality epidemics throughout human history, including the Plague of Justinian in 542 CE and the black death, accounted for the death of at least one-third of the European population between 1347 and 1353 CE. It is demonstrated conclusively that these plagues originated in rodent populations in China.
Historical Perspective
It is suggested that Yersinia pestis infection was a contributing factor in some of (though possibly not all) the European plagues. The earliest account describing a possible plague epidemic is found in I Samuel 5:6 of the Hebrew Bible (Tanakh). In this account, the Philistines of Ashdod were stricken with a plague for the crime of stealing the Ark of the Covenant from the Children of Israel. These events have been dated to approximately the second half of the 11th century BC.
Classification
The classification of plague depends on the mode of infection and the clinical syndrome. Plague can be classified into bubonic plague, septicemic plague, or pneumonic plague.
Pathophysiology
Plague can be transmitted from flea bites or the inhalation of aerosol from an individual who has plague pneumonia. Pathogenesis due to the Yersinia pestis infection of mammalian hosts, results from several factors including the bacteria's avoidance of normal immune system responses, such as phagocytosis and antibody production.
Causes
Yersinia pestis (Y. pestis), a rod-shaped facultative anaerobe with bipolar staining (giving it a safety pin appearance) causes the infection in mammals and humans.[1] The bacteria maintain their existence in a cycle involving rodents and their fleas. The genus Yersinia is gram-negative, bipolar staining coccobacilli, and, similarly to other Enterobacteriaceae, it has a fermentative metabolism. Y. pestis produces an antiphagocytic slime. The organism is motile when isolated, but becomes nonmotile in the mammalian host.
Differential Diagnosis
The differential diagnosis for yersina pestis infection is dependent on the clinical syndrome (bubonic plague, septicimic plague, pneumonic plague, or pharyngeal plague). Bubonic plague should be differentiated from other causes of lymphadenopathy, such as streptococcal or staphylococcal lymphadenitis, infectious mononucleosis, cat-scratch fever, and tularemia. Septicemic plague should be differentiated from non-specific sepsis syndrome and gram negative sepsis. The differential diagnosis for pneumonic plague includes infections that cause community-acquired pneumonia, such as pneumococcal or streptococcal pneumonia, viral pneumonia, hemophilus influenzae, and anthrax.[2]
Risk Factors
Outbreaks in people occur in areas where housing and sanitation conditions are poor. These outbreaks can occur in rural communities or in cities. They are usually associated with infected rats and rat fleas that live in the home.
Natural History, Complications and Prognosis
If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. About 14% (1 in 7) of all plague cases in the United States are fatal.
Diagnosis
History and Symptoms
Symptoms of plague may be differentiated by type: Bubonic, septicemic, and pneumonic. Although all 3 types share constitutional symptoms, key features differentiate them from one another. Not only do the 3 types differ in symptoms, but also in treatment and prognosis.[3] Bubonic plague is characterized by the presence of painful and tender lymphadenopathy, called buboes. Less pathognomonic features are found in other types of plague, making their diagnosis more difficult.[3] Septicemic plague follows the course, along with signs and symptoms, of a gram-negative bacilli and pneumonic plague presents with a virulent pneumonia.[4]
Physical Examination
Apart from the presence of buboes, which are tender lymph nodes in patients infected with bubonic plague, the physical examination findings are not specific to plague. Nonetheless, physical examination is crucial to evaluate for the presence of target organ damage or the progression and worsening of infection burden in these patients.[3]
Treatment
Medical Therapy
According to treatment experts, a patient diagnosed with suspected plague should be hospitalized and medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of lymph gland, blood, and sputum samples. Antibiotic treatment should begin as soon as possible after laboratory specimens are taken. Effective antibiotics are streptomycin, gentamicin (used when streptomycin is not available), tetracyclines and chloramphenicol. (used for critically ill patients, or rarely for suspected neuro-involvement)
Primary Prevention
A plague vaccine is not currently available for use in the United States. Preventive measures are directed to home, work, and recreational settings where the risk of acquiring plague is high.
References
- ↑ Collins FM (1996). Pasteurella, Yersinia, and Francisella. In: Baron's Medical Microbiology (Baron S et al, eds.) (4th ed.). Univ. of Texas Medical Branch. ISBN 0-9631172-1-1.
- ↑ Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response and Control. WHO/CDS/CSR/EDC/99.2
- ↑ 3.0 3.1 3.2 "Plague". Centers for Disease Control and Prevention. CDC. Jun 13 2012. Retrieved Jul 25 2014. Check date values in:
|accessdate=, |date=(help) - ↑ Koirala J (2006). "Plague: disease, management, and recognition of act of terrorism". Infect Dis Clin North Am. 20 (2): 273–87, viii. doi:10.1016/j.idc.2006.02.004. PMID 16762739.