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==Pathophysiology==
==Pathophysiology==
''Yersinia pestis'' is the bacteria that causes the bubonic plague , or [[black death]]. Typically during the incubation period of the disease, buboes form under the armpits and in the groin area. These buboes are located where the lymph nodes are because that is the location that the bacteria congregates during infection. If untreated, the plague will spread rapidly and cause infection of many other organs.
''Yersinia pestis'' is the bacteria that causes the bubonic plague, or [[black death]]. Typically during the incubation period of the disease, buboes form under the armpits and in the groin area. These buboes are located where the lymph nodes are because that is the location that the bacteria congregates during infection. If untreated, the plague will spread rapidly and cause infection of many other organs.


==Causes==
==Causes==

Revision as of 17:51, 19 December 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The bubonic plague is the best-known variant of the deadly infectious disease caused by the enterobacteria Yersinia pestis. The epidemiological use of the term plague is currently applied to bacterial infections that cause buboes, although historically the medical use of the term plague has been applied to pandemic infections in general.

Historical Perspective

The bubonic plague is one of the most infamous diseases in the history of the human race. There have been nursery rhymes, documentaries, movies, etc about the bubonic plague. The first possible accounts of a plague-like disease were made as early as the 11th century BC. One of the most famous pandemics of the plague was in 1347 in Eurasia where 1/3 to 1/2 of the population was wiped out. This is the time period where the term black death was used to describe the bubonic plague.

Pathophysiology

Yersinia pestis is the bacteria that causes the bubonic plague, or black death. Typically during the incubation period of the disease, buboes form under the armpits and in the groin area. These buboes are located where the lymph nodes are because that is the location that the bacteria congregates during infection. If untreated, the plague will spread rapidly and cause infection of many other organs.

Causes

People can get the plague when they are bitten by a flea that carries the plague bacteria from an infected rodent.

Differentiating Bubonic Plague from other Diseases

There are many diseases that resemble the basic signs and symptoms of bubonic plague. Since bubonic plague has the ability to kill the majority of a population, it is an extremely concerning diagnosis. It is very important to check for these other diseases before a final diagnosis of bubonic plague is made. There are many other bacterial infections that could be mistaken for the bubonic plague.

Epidemiology and Demographics

Since the last urban plague epidemic, which happened in Los Angeles in the mid 1920s, the disease has become very scattered. Since the mid 1920s there have been approximately 10 to 15 cases per year.

Risk Factors

Those people who lived in the middle ages were at extremely high risk due to the contagious nature of the disease. Also, there were many rats living close to the people who were infected with the bubonic plague. Rats are one of many rodents that can be a carrier for Yersinia pestis or the bubonic plague.

Treatment

Medical Therapy

Antibiotics of choice for bubonic plague include streptomycin, chloramphenicol, tetracycline, gentamycin and doxycycline.

Surgery

There really isn't a definite surgical procedure involved with bubonic plague. The only procedure that could be considered surgical in nature has to do with the buboes that form on the lymph nodes. At times in the past, physicians though that the bubo needed to be aspirated. This was found out to have unwanted side effects because the fluid from the bubo will contain the Yersinia Pestis bacteria. In modern medicine, the bubo will be treated with antibiotic therapy in which it will eventually recede. If the bubo were to burst, it may cause more serious infections than the patient initially had.

Primary 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.

Future and Investigational Therapies

The main investigational technique being looked into is that of a vaccine to stop any possible plague outbreaks. Currently, there is not an available vaccine against the plague, particularly the pneumonic version. This all may be changing because there has been research conducted giving promising results for a vaccine against the pneumonic plague.

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