Plague

Yersinia pestis, a tiny germ, is the cause of plague, a serious illness. This germ mainly lives in small animals like rodents and their fleas. Most people get plague when a flea carrying the germ bites them.

Plague is uncommon. It primarily affects a limited number of countries. In the United States, it's usually found in a small number of people each year, often in rural or semi-rural areas of western states.

Fortunately, plague is usually treatable with antibiotics. Without treatment, it can be life-threatening.

Because of its potential to be used as a weapon, plague is considered a serious concern. The U.S. government has plans and medical resources ready to deal with plague if it's used in an attack. This includes having specific treatments and strategies in place.

The plague comes in three forms, each with different symptoms.

Bubonic Plague: This type of plague affects the lymph nodes, which are small, bean-shaped parts of your immune system. Imagine tiny filters throughout your body. When the plague bacteria attack, these lymph nodes swell up. This swollen lymph node is called a bubo. The name "bubonic" comes from this swelling. Buboes usually appear in the armpits, groin, or neck and are tender or painful. They can be very small, less than a half-inch across, or as large as 4 inches. Other symptoms include:

• A sudden, high fever and chills
• Headache
• Feeling tired and unwell
• Weakness
• Muscle aches
• In rare cases, skin sores

Septicemic Plague: In this form, the plague bacteria multiply directly in your bloodstream. This means you might not have swollen lymph nodes (buboes). Early symptoms are often general, including:

• A sudden, high fever and chills
• Extreme weakness
• Stomach pain, diarrhea, and vomiting.

As the infection progresses, more serious symptoms can develop, such as:

• Bleeding from your mouth, nose, or rectum, or under your skin
• Signs of shock, like seizures, a rash, and low blood pressure
• Blackening and death of tissue (gangrene), often affecting the fingers, toes, ears, and nose.

Pneumonic Plague: This type of plague affects the lungs. It can start in the lungs or spread there from infected lymph nodes. Symptoms appear quickly and get worse fast, often within a few hours of exposure. These symptoms include:

• A sudden, high fever and chills
• Coughing up bloody mucus
• Difficulty or irregular breathing
• Chest pain
• Upset stomach and vomiting
• Headache
• Weakness

Without immediate treatment, pneumonic plague can quickly lead to lung failure, shock, and death.

Important Note: If you experience a sudden high fever, seek immediate medical attention, especially if you live in an area where plague cases have been reported. In the western United States, areas like Arizona, California, Colorado, and New Mexico have seen cases. Plague has also been found in parts of Africa, Asia, and Latin America, including countries like Madagascar, the Democratic Republic of Congo, and Peru.

If you suddenly get a very high fever, see a doctor right away.

If you have a sudden high fever and other symptoms, and you live somewhere that's had plague cases, get emergency medical help. In the western US, most plague cases recently have been in Arizona, California, Colorado, and New Mexico.

Plague cases have also been reported in Africa, Asia, and Latin America. Some areas with a higher number of cases include Madagascar, the Democratic Republic of Congo, and Peru. It's important to remember that you should always seek medical attention if you're concerned about your health.

The plague is a disease caused by a bacteria called Yersinia pestis. This bacteria lives in the bodies of small animals, like rodents, and their fleas.

In the western United States, these small animals include rats, mice, voles, squirrels, rabbits, prairie dogs, ground squirrels, and chipmunks. These animals often carry the bacteria without getting sick themselves. Flea bites from infected animals can spread the bacteria.

Other animals can also get the plague. For example, if a cat or dog eats a small infected animal, or if they get bitten by an infected flea, they could become infected. Coyotes and wild cats are also at risk.

People usually get the plague from a flea bite. These fleas can come from the small wild animals mentioned above, or even from infected pets. The flea's bite injects the bacteria into the person's bloodstream.

A person can also get the plague through direct contact with the tissues of a sick animal. For example, if a hunter handles a diseased animal while skinning or preparing it, they might get infected. Touching the animal's body fluids or tissues can introduce the bacteria into a cut or scrape on the skin.

A serious form of the plague, called pneumonic plague, can spread from animals to people, and from person to person. When a sick person or animal coughs or sneezes, tiny droplets carrying the bacteria are released into the air. If someone breathes in these droplets, or touches coughed-up mucus, they can become infected. This is why it's important to avoid close contact with sick people or animals.

Getting plague is rare. Globally, only a few thousand people contract plague each year. In the United States, about seven people get it each year on average.

Plague has been found in many countries around the world. Some areas where it's more common include Madagascar, the Democratic Republic of Congo, and Peru. Madagascar, in particular, often sees outbreaks annually.

In the western United States, plague is sometimes seen in Arizona, California, Colorado, and New Mexico.

Plague usually lives in rodents and the fleas that bite them. This is most often in rural or semi-rural areas. But, it can also happen in cities with lots of rats, poor sanitation, or crowded conditions.

People who spend time outdoors in places with lots of rodents are at higher risk of getting plague. This includes people who work in outdoor jobs in these areas. Veterinarians or animal clinic staff in these regions may also be at risk from contact with infected pets, such as cats or dogs.

Activities like camping, hunting, or hiking in areas with rodents can increase the risk of being bitten by an infected flea. This is because fleas can carry the plague bacteria.

The US government considers plague a possible biological weapon. There's a history of plague being used as, or experimented with as, a weapon. The government has specific guidelines for how to treat and prevent plague if it's used as a weapon.

Plague can have serious complications:

• Gangrene: Blood clots can form in small blood vessels, like those in the fingers, toes, nose, and ears. This can cause the tissue to die. Doctors will need to remove the dead tissue.

• Meningitis: In rare cases, plague can cause inflammation and damage to the protective membranes around the brain and spinal cord. This is known as meningitis.

• Pharyngeal Plague: Sometimes, the infection is found in the tissues behind the nose and mouth (the pharynx). This is called pharyngeal plague.

The chance of dying from plague in the US is about 11%.

Most people with bubonic plague get better if diagnosed and treated quickly. Septicemic plague is more dangerous because it's often hard to spot early and gets worse quickly, potentially leading to delayed treatment.

Pneumonic plague is very serious and progresses rapidly. If treatment isn't started within 24 hours of symptoms appearing, the risk of death is much higher. This is why quick diagnosis and prompt treatment are so crucial.

The plague is a serious illness, but there's no vaccine yet. Scientists are working on one. If you think you might have been exposed to plague, antibiotics can help.

People with a lung form of plague (pneumonic plague) need to be kept separate from others during treatment to stop the disease from spreading. Doctors and nurses treating them must wear special protective gear, like masks, gowns, gloves, and eye protection.

If you live or spend time in areas where plague is common, you can take steps to protect yourself:

Protecting Your Home and Yourself:

• Get rid of rodent hiding places: Rodents like to nest in piles of wood, rocks, brush, and junk. Keep these things away from your home. Also, don't leave pet food out where rodents can get to it. If you see signs of rodents, take steps to get rid of them. This helps prevent them from getting inside your home and spreading the disease.
• Protect your pets: Use flea and tick prevention products recommended by your veterinarian. If your pet seems sick, take them to the vet right away. If your pet spends time outdoors in areas where plague is present, try to keep them separate from you at night.
• Handling dead animals safely: If you find a dead animal, wear gloves to avoid touching it directly. Contact your local health department for advice on how to handle the animal safely.
• Insect repellent: When you're outdoors, use insect repellent containing ingredients approved by the U.S. Environmental Protection Agency (EPA). These include DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), para-menthane-3,8-diol (PMD), or 2-undecanone. Important notes:
  • Apply repellent to your clothing and skin, but not directly to your face.
  • Don't use products with OLE or PMD on children under 3 years old.
  • Never use insect repellent on a baby under 2 months old.

By taking these precautions, you can significantly reduce your risk of contracting plague. Remember to always follow the advice of your healthcare provider and local health officials.

Doctors suspect plague based on several clues:

• Symptoms: Noticeable signs of illness, like fever, chills, and weakness.
• Recent Activities: If you've been hiking, camping, or traveling to areas where plague is found recently.
• Animal Contact: If you've handled or been near a dead or sick animal, especially rodents like rats or squirrels.
• Flea Bites: If you have a known flea bite or have been exposed to fleas.

Treatment for plague often begins before lab results confirm the presence of the bacteria Yersinia pestis. This is because quick action is crucial. Doctors need to start treatment as soon as possible. To confirm the diagnosis, the doctor will take samples for lab tests. These samples may include:

• Fluid from swollen lymph nodes (buboes): Swollen lymph nodes are a common sign of plague.
• Blood: A blood sample can provide valuable information about the infection.
• Lung fluid (if pneumonia is involved): If the plague has spread to the lungs, a sample of fluid from the lungs will be collected.
• Fluid surrounding the brain and spinal cord (if meningitis is involved): In some cases, the infection can spread to the brain and spinal cord, requiring samples to be taken from the fluid around these areas.

These samples are sent to a lab to identify the bacteria. Knowing what kind of plague you have (bubonic, septicemic, or pneumonic) is important for determining the best treatment.