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plague, any contagious, malignant, epidemic disease, in particular the bubonic plague and the black plague (or Black Death), both forms of the same infection. These acute febrile diseases are caused by Yersinia pestis (Pasteurella pestis), discovered independently by Shibasaburo Kitasato and Alexandre Yersin in 1894, a bacterium that is transmitted to people by fleas from rats, in which epidemic waves of infection always precede great epidemics in human populations. Sylvatic plague, still another form, is carried by other rodents, e.g., squirrels, rabbits, chipmunks, in rural or wooded areas where they are prevalent.

Bubonic plague, the most common form, is characterized by very high fever, chills, prostration, delirium, hemorrhaging of the small capillaries under the skin, and enlarged, painful lymph nodes (buboes), which suppurate and may discharge. Invasion of the lungs by the organism (pneumonic plague) may occur as a complication of the bubonic form or as a primary infection. Pneumonic plague is rapidly fatal and is the only type that can be spread from person to person (by droplet spray) without intermediary transmission by flea. In the black form of plague, hemorrhages turn black, giving the term "Black Death" to the disease. An overwhelming infection of the blood may cause death in three or four days, even before other symptoms appear.

In untreated cases of bubonic plague the mortality rate is approximately 50%–60%; pneumonic plague is usually fatal if not treated within 24 hours. Such antibiotics as streptomycin and tetracycline greatly reduce the mortality rate. Vaccine is available for preventive purposes. Rodent control is important in areas of known infection.

History

The earliest known visitation of the plague to Europe may have occurred in Athens in 430 B.C., but it is unclear if the disease that afflicated Athens was caused by Yersina pestis. A disastrous epidemic occurred in the Mediterranean during the time of the Roman emperor Justinian; an estimated 25% to 50% of the population is reported to have succumbed. The most widespread epidemic began in Constantinople in 1334, spread throughout Europe (returning Crusaders were a factor), and in less than 20 years is estimated to have killed three quarters of the population of Europe and Asia. The great plague of London in 1665 is recorded in many works of literature. Quarantine measures helped contain the disease, but serious epidemics continued to occur even in the 19th cent. The disease is still prevalent in parts of Asia, and sporadically occurs elsewhere (approximately 2,500 cases worldwide annually). In Surat, India, in 1994, 5,000 cases of pneumonic plague were reported in an outbreak; an estimated 100 people died, and more than 400,000 people fled the city. Because the number of cases of plague has been increasing annually, it is categorized as a re-emerging infectious disease by the World Health Organization.

Bibliography

See P. Ziegler, The Black Death (1969); W. Whitman, Travel in Turkey, Asia Minor, Syria and Egypt (1971); R. S. Gottfried, The Black Death (1983); G. Twigg, The Black Death: A Biological Reappraisal (1985); R. Horrox, ed., The Black Death (1994); O. J. Benedictow, The Black Death 1346–1353: The Complete History (2004); W. Orent, Plague (2004); J. Aberth, The Black Death: The Great Mortality of 1348–1350 (2005); J. Kelly, The Great Mortality: An Intimate History of the Black Death (2005).

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plague

Infectious fever caused by the bacterium Yersinia pestis, carried by the rat flea. It usually spreads to humans only when the flea runs out of rodent hosts. It takes three forms. Bubonic, the mildest, has characteristic swollen lymph nodes (buboes) and is spread only by the flea. It accounts for three-fourths of plague cases. Pneumonic plague has extensive lung involvement and is spread in droplets from the lungs; it is often fatal in three or four days without treatment. In septicemic plague, bacteria overwhelm the bloodstream and often cause death within 24 hours, before other symptoms have a chance to develop. In the 14th century, plague ravaged Europe and Asia and was called the Black Death. Plague does not respond to penicillin, but other antibiotics are effective. Sanitary measures against fleas and rodents, quarantine, and extreme caution in handling infectious materials help to suppress epidemics. A vaccine can prevent plague.

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plague

1. any widespread and usually highly contagious disease with a high fatality rate

2. an infectious disease of rodents, esp rats, transmitted to man by the bite of the rat flea (Xenopsylla cheopis)

3. See bubonic plague

4. a pestilence, affliction, or calamity on a large scale, esp when regarded as sent by God

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plague [plāg]

(medicine)

An infectious bacterial disease of rodents and humans caused byPasteurella pestis,transmitted to humans by the bite of an infected flea (Xenopsylla cheopis) or by inhalation. Also known as black death; bubonic plague.

Any contagious, malignant, epidemic disease.

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Plague

An infectious disease of humans and rodents caused by the bacterium Yersinia pestis. The sylvatic (wild-animal) form persists today in more than 200 species of rodents throughout the world. The explosive urban epidemics of the Middle Ages, known as the Black Death, resulted when the infection of dense populations of city rats living closely with humans introduced disease from the Near East. The disease then was spread both by rat fleas and by transmission between humans. During these outbreaks, as much as 50% of the European population died. At present, contact with wild rodents and their fleas, sometimes via domestic cats and dogs, leads to sporadic human disease. See Infectious disease

After infection by Y. pestis, fleas develop obstruction of the foregut, causing regurgitation of plague bacilli during the next blood meal. The rat flea, Xenopsylla cheopsis, is an especially efficient plague vector, both between rats and from rats to humans. Human (bubonic) plague is transmitted by the bite of an infected flea; after several days, a painful swelling (the bubo) of local lymph nodes occurs. Bacteria can then spread to other organ systems, especially the lung; fever, chills, prostration, and death may occur. Plague pneumonia develops in 10–20% of all bubonic infections. In some individuals, the skin may develop hemorrhages and necrosis (tissue death), probably the origin of the ancient name, the Black Death. The last primary pneumonic plague outbreak in the United States occurred in 1919, when 13 cases resulting in 12 deaths developed before the disease was recognized and halted by isolation of cases.

Bubonic plaque is suspected when the characteristic painful, swollen glands develop in the groin, armpit, or neck of an individual who has possibly been exposed to wild-animal fleas in an area where the disease is endemic. Immediate identification is possible by microscopic evaluation of bubo aspirate stained with fluorescent-tagged antibody. Antibiotics should be given if plague is suspected or confirmed. Such treatment is very effective if started early. The current overall death rate, approximately 15%, is reduced to less than 5% among patients treated at the onset of symptoms. See Immunofluorescence, Medical bacteriology