Bubonic plague is one of three types of plague caused by bacterium Yersinia pestis. One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting. Swollen and painful lymph nodes occur in the area closest to where the bacteria entered the skin. Occasionally, the swollen lymph nodes may break open.
The three types of plague are the result of the route of infection: bubonic plague, septicemic plague, and pneumonic plague. Bubonic plague is mainly spread by infected fleas from small animals. It may also result from exposure to the body fluids from a dead plague-infected animal. In the bubonic form of plague, the bacteria enter through the skin through a flea bite and travel via the lymphatic vessels to a lymph node, causing it to swell. Diagnosis is made by finding the bacteria in the blood, sputum, or fluid from lymph nodes.
Prevention is through public health measures such as not handling dead animals in areas where plague is common. Vaccines have not been found to be very useful for plague prevention. Several antibiotics are effective for treatment, including streptomycin, gentamicin, and doxycycline. Without treatment, plague results in the death of 30% to 90% of those infected. Death, if it occurs, is typically within ten days. With treatment the risk of death is around 10%. Globally there are about 650 documented cases a year, which result in ~120 deaths. In the 21st century, the disease is most common in Africa.
The plague is believed to be the cause of the Black Death that swept through Asia, Europe, and Africa in the 14th century and killed an estimated 50 million people. This was about 25% to 60% of the European population. Because the plague killed so many of the working population, wages rose due to the demand for labor. Some historians see this as a turning point in European economic development. The term bubonic is derived from the Greek word βουβών, meaning "groin". The term "buboes" is also used to refer to the swollen lymph nodes.
|A bubo on the upper thigh of a person infected with bubonic plague.|
|Symptoms||Fever, headaches, vomiting, swollen lymph nodes|
|Usual onset||1–7 days after exposure|
|Causes||Yersinia pestis spread by fleas|
|Diagnostic method||Finding the bacteria in the blood, sputum, or lymph nodes|
|Treatment||Antibiotics such as streptomycin, gentamicin, or doxycycline|
|Frequency||650 cases reported a year|
|Deaths||10% mortality with treatment|
The best-known symptom of bubonic plague is one or more infected, enlarged, and painful lymph nodes, known as buboes. After being transmitted via the bite of an infected flea, the Y. pestis bacteria become localized in an inflamed lymph node, where they begin to colonize and reproduce. Buboes associated with the bubonic plague are commonly found in the armpits, upper femoral, groin and neck region. Acral gangrene (i.e., of the fingers, toes, lips and nose) is another common symptom.
Because of its bite-based mode of transmission, the bubonic plague is often the first of a progressive series of illnesses. Bubonic plague symptoms appear suddenly a few days after exposure to the bacterium. Symptoms include:
Other symptoms include heavy breathing, continuous vomiting of blood (hematemesis), aching limbs, coughing, and extreme pain caused by the decay or decomposition of the skin while the person is still alive. Additional symptoms include extreme fatigue, gastrointestinal problems, lenticulae (black dots scattered throughout the body), delirium, and coma.
Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, Xenopsylla cheopis (the rat flea). In very rare circumstances, as in the septicemic plague, the disease can be transmitted by direct contact with infected tissue or exposure to the cough of another human. The flea is parasitic on house and field rats, and seeks out other prey when its rodent hosts die. The bacteria remain harmless to the flea, allowing the new host to spread the bacteria. The bacteria form aggregates in the gut of infected fleas and this results in the flea regurgitating ingested blood, which is now infected, into the bite site of a rodent or human host. Once established, bacteria rapidly spread to the lymph nodes and multiply.
Y. pestis bacilli can resist phagocytosis and even reproduce inside phagocytes and kill them. As the disease progresses, the lymph nodes can haemorrhage and become swollen and necrotic. Bubonic plague can progress to lethal septicemic plague in some cases. The plague is also known to spread to the lungs and become the disease known as the pneumonic plague.
Laboratory testing is required in order to diagnose and confirm plague. Ideally, confirmation is through the identification of Y. pestis culture from a patient sample. Confirmation of infection can be done by examining serum taken during the early and late stages of infection. To quickly screen for the Y. pestis antigen in patients, rapid dipstick tests have been developed for field use.
Samples taken for testing include:
Several classes of antibiotics are effective in treating bubonic plague. These include aminoglycosides such as streptomycin and gentamicin, tetracyclines (especially doxycycline), and the fluoroquinolone ciprofloxacin. Mortality associated with treated cases of bubonic plague is about 1–15%, compared to a mortality of 40–60% in untreated cases.
People potentially infected with the plague need immediate treatment and should be given antibiotics within 24 hours of the first symptoms to prevent death. Other treatments include oxygen, intravenous fluids, and respiratory support. People who have had contact with anyone infected by pneumonic plague are given prophylactic antibiotics. Using the broad-based antibiotic streptomycin has proven to be dramatically successful against the bubonic plague within 12 hours of infection.
The first recorded epidemic affected the Eastern Roman Empire (Byzantine Empire) and was named the Plague of Justinian after emperor Justinian I, who was infected but survived through extensive treatment. The pandemic resulted in the deaths of an estimated 25 million (6th century outbreak) to 50 million people (two centuries of recurrence). The historian Procopius wrote, in Volume II of History of the Wars, of his personal encounter with the plague and the effect it had on the rising empire. In the spring of 542, the plague arrived in Constantinople, working its way from port city to port city and spreading around the Mediterranean Sea, later migrating inland eastward into Asia Minor and west into Greece and Italy. Because the infectious disease spread inland by the transferring of merchandise through Justinian's efforts in acquiring luxurious goods of the time and exporting supplies, his capital became the leading exporter of the bubonic plague. Procopius, in his work Secret History, declared that Justinian was a demon of an emperor who either created the plague himself or was being punished for his sinfulness.
In the Late Middle Ages (1340–1400) Europe experienced the most deadly disease outbreak in history when the Black Death, the infamous pandemic of bubonic plague, hit in 1347, killing a third of the European human population. Some historians believe that society subsequently became more violent as the mass mortality rate cheapened life and thus increased warfare, crime, popular revolt, waves of flagellants, and persecution. The Black Death originated in Central Asia and spread from Italy and then throughout other European countries. Arab historians Ibn Al-Wardni and Almaqrizi believed the Black Death originated in Mongolia. Chinese records also showed a huge outbreak in Mongolia in the early 1330s. Research published in 2002 suggests that it began in early 1346 in the steppe region, where a plague reservoir stretches from the northwestern shore of the Caspian Sea into southern Russia. The Mongols had cut off the trade route, the Silk Road, between China and Europe which halted the spread of the Black Death from eastern Russia to Western Europe. The epidemic began with an attack that Mongols launched on the Italian merchants' last trading station in the region, Caffa in the Crimea. In late 1346, plague broke out among the besiegers and from them penetrated into the town. When spring arrived, the Italian merchants fled on their ships, unknowingly carrying the Black Death. Carried by the fleas on rats, the plague initially spread to humans near the Black Sea and then outwards to the rest of Europe as a result of people fleeing from one area to another.
The plague resurfaced for a third time in the mid-19th century. Like the two previous outbreaks, this one also originated in Eastern Asia, most likely in Yunnan Province of China, where there are several natural plague foci. The initial outbreaks occurred in the second half of the eighteenth century. The disease remained localized in Southwest China for several years before spreading. In the city of Canton, beginning in January 1894, the disease killed 80,000 people by June. Daily water-traffic with the nearby city of Hong Kong rapidly spread the plague there, killing over 2,400 within two months.
Also known as the modern pandemic, the third pandemic spread the disease to port cities throughout the world in the second half of the 19th century and early 20th century via shipping routes. The plague inflicted people in Chinatown in San Francisco from 1900 to 1904, and the people of Oakland and east bay again from 1907-1909. During the outbreak from 1900 to 1904 in San Francisco is when authorities made permanent the Chinese Exclusion Act. This law was originally signed into existence by President Chester A. Arthur in 1882. The Chinese Exclusion Act was supposed to last for ten years but was renewed in 1892 with the Geary Act and subsequently made permanent in 1902 during the outbreak of plague in Chinatown, San Francisco. The last major outbreak in the United States occurred in Los Angeles in 1924, though the disease is still present in wild rodents, and can be passed to humans that come in contact with them. According to the World Health Organization, the pandemic was considered active until 1959, when worldwide casualties dropped to 200 per year. In 1994, a plague outbreak in five Indian states caused an estimated 700 infections (including 52 deaths) and triggered a large migration of Indians within India as they tried to avoid the plague.
For over a decade since 2001, Zambia, India, Malawi, Algeria, China, Peru, and the Democratic Republic of the Congo had the most plague cases with over 1,100 cases in the Democratic Republic of the Congo alone. From 1,000 to 2,000 cases are conservatively reported per year to the WHO. From 2012 to 2017, reflecting political unrest and poor hygienic conditions, Madagascar began to host regular epidemics.
Between 1900 and 2015, the United States had 1,036 human plague cases with an average of 9 cases per year. In 2015, 16 people in the Western United States developed plague, including 2 cases in Yosemite National Park. These US cases usually occur in rural northern New Mexico, northern Arizona, southern Colorado, California, southern Oregon, and far western Nevada.
In November 2017, the Madagascar Ministry of Health reported an outbreak to WHO (World Health Organization) with more cases and deaths than any recent outbreak in the country. Unusually most of the cases were pneumonic rather than bubonic.
The scale of death and social upheaval associated with plague outbreaks has made the topic prominent in a number of historical and fictional accounts since the disease was first recognized. The Black Death in particular is described and referenced in numerous contemporary sources, some of which, including works by Chaucer, Boccaccio, and Petrarch, are considered part of the Western canon. The Decameron, by Boccaccio, is notable for its use of a frame story involving individuals who have fled Florence for a secluded villa to escape the Black Death. First-person, sometimes sensationalized or fictionalized, accounts of living through plague years have also been popular across centuries and cultures.
Later works, such as Albert Camus's novel The Plague or Ingmar Bergman's film The Seventh Seal have used bubonic plague in settings, such quarantined cities in either medieval or modern times, as a backdrop to explore a variety of concepts. Common themes include the breakdown of society, institutions, and individuals during the plague, the cultural and psychological existential confrontation with mortality, and the allegorical use of the plague in reference to contemporary moral or spiritual questions.
Some of the earliest instances of biological warfare were said to have been products of the plague, as armies of the 14th century were recorded catapulting diseased corpses over the walls of towns and villages to spread the pestilence.
Later, plague was used during the Second Sino-Japanese War as a bacteriological weapon by the Imperial Japanese Army. These weapons were provided by Shirō Ishii's units and used in experiments on humans before being used on the field. For example, in 1940, the Imperial Japanese Army Air Service bombed Ningbo with fleas carrying the bubonic plague. During the Khabarovsk War Crime Trials, the accused, such as Major General Kiyashi Kawashima, testified that, in 1941, 40 members of Unit 731 air-dropped plague-contaminated fleas on Changde. These operations caused epidemic plague outbreaks.
The great waves of plague that twice devastated Europe and changed the course of history had their origins in China, a team of medical geneticists reported Sunday, as did a third plague outbreak that struck less harmfully in the 19th century.
The Italian Plague of 1629–1631 was a series of outbreaks of bubonic plague which ravaged northern and central Italy. This epidemic, often referred to as the Great Plague of Milan, claimed possibly one million lives, or about 25% of the population. This episode is considered one of the later outbreaks of the centuries-long pandemic of bubonic plague which began with the Black Death.Black Death
The Black Death, also known as the Great Plague, the Black Plague, or simply the Plague, was one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people in Eurasia and peaking in Europe from 1347 to 1351. The bacterium Yersinia pestis, which results in several forms of plague, is believed to have been the cause. The Black Death was the first major European outbreak of the second plague pandemic. The plague created a series of religious, social and economic upheavals, which had profound effects on the course of European history.
The Black Death is thought to have originated in the dry plains of Central Asia, where it travelled along the Silk Road, reaching Crimea by 1343. From there, it was most likely carried by Oriental rat fleas living on the black rats that were regular passengers on merchant ships, spreading throughout the Mediterranean Basin and Europe.
The Black Death is estimated to have killed 30–60% of Europe's total population. In total, the plague may have reduced the world population from an estimated 450 million down to 350–375 million in the 14th century. It took 200 years for the world population to recover to its previous level. The plague recurred as outbreaks in Europe until the 19th century.Bombay plague epidemic
The Bombay plague epidemic was a bubonic plague epidemic that struck the city of Mumbai (then known as Bombay) in the late nineteenth century. The plague killed thousands, and many fled the city leading to a drastic fall in the population of the city.Bubo
A bubo (Greek βουβών, boubôn, "groin") is defined as adenitis or inflammation of the lymph nodes.Buboes are a symptom of bubonic plague, and occur as painful swellings in the thighs, neck, groin or armpits. They are caused by Yersinia pestis bacteria spreading from flea bites through the bloodstream to the lymph nodes, where the bacteria replicate, causing the nodes to swell. Plague buboes may turn black and rot away the surrounding tissue, or they may discharge large amounts of pus. Infection can spread from buboes around the body, resulting in other forms of the disease such as pneumonic plague.Plague patients whose buboes swell to such a size that they burst tend to survive the disease. Before the discovery of antibiotics, doctors often drained buboes to save patients.Buboes are also symptoms of other diseases, such as chancroid and lymphogranuloma venereum. In these conditions, a course of antibiotics is the recommended treatment, and incision and drainage or excision of the swollen lymph nodes is to be avoided.Chinatown, Honolulu
The Chinatown Historic District is a Chinatown neighborhood of Honolulu, Hawaii known for its Chinese American community, and is one of the oldest Chinatowns in the United States.Freston, Suffolk
Freston is a small village and civil parish in the Babergh district, in the county of Suffolk, England, located on the Shotley Peninsula, 4 miles south-east of Ipswich. In 2001 the parish had a population of 122, reducing slightly to 120 at the 2011 Census.Great Plague of London
The Great Plague, lasting from 1665 to 1666, was the last major epidemic of the bubonic plague to occur in England. It happened within the centuries-long time period of the Second Pandemic, an extended period of intermittent bubonic plague epidemics which originated in China in 1331, the first year of the Black Death, an outbreak which included other forms such as pneumonic plague, and lasted until 1750.The Great Plague killed an estimated 100,000 people—almost a quarter of London's population—in 18 months. The plague was caused by the Yersinia pestis bacterium, which is usually transmitted through the bite of an infected rat flea.The 1665–66 epidemic was on a far smaller scale than the earlier Black Death pandemic; it was remembered afterwards as the "great" plague mainly because it was the last widespread outbreak of bubonic plague in England during the 400-year timespan of the Second Pandemic.Henry Gage
Henry Tifft Gage (December 25, 1852 – August 28, 1924) was an American lawyer, politician and diplomat. A Republican, Gage was elected to a single term as the 20th governor of California from 1899 to 1903. Gage was also the U.S. Minister to Portugal for several months in 1910.List of epidemics
This article is a list of epidemics of infectious disease. Widespread and chronic complaints such as heart disease and allergy are not included if they are not thought to be infectious.Little Staughton
Little Staughton is a small village and civil parish located in the north of Bedfordshire. The parish is part of the Stodden Hundred (which comprises Bolnhurst, Clapham, Dean and Shelton, Keysoe, Knotting, Little Staughton, Melchbourne, Milton Ernest, Oakley, Pertenhall & Swineshead, Riseley, Shelton, Tilbrook and Yelden). The parish church, All Saints, is set apart from the present village – the previous village having been abandoned following an outbreak of the Bubonic plague.
During World War II it was the home of 109 Squadron (Mosquito bombers) and 582 Squadron (Lancaster bombers).
The airfield is now largely used for other purposes but retains a recently listed Control tower.Mass grave
A mass grave is a grave containing multiple human corpses, which may or may not be identified prior to burial. The United Nations has defined a criminal mass grave as a burial site containing three or more victims of execution. Mass graves are usually created after a large number of people die or are killed, and there is a desire to bury the corpses quickly for sanitation concerns. Although mass graves can be used during major conflicts such as war and crime, in modern times they may be used after a famine, epidemic, or natural disaster. In disasters, mass graves are used for infection and disease control. In such cases, there is often a breakdown of the social infrastructure that would enable proper identification and disposal of individual bodies.Oswaldo Cruz Foundation
The Oswaldo Cruz Foundation (Portuguese Fundação Oswaldo Cruz, also known as FIOCRUZ) is a scientific institution for research and development in biological sciences located in Rio de Janeiro, Brazil, it is considered one of the world's main public health research institutions. It was founded by Dr. Oswaldo Cruz, a noted physician and epidemiologist.
The organization started in 1898 as the Federal SeroTherapy Institute with the objective of developing serum and vaccines against the bubonic plague. It was located outside of Rio de Janeiro. The institute’s activities, however, changed from simple production into research and experimental medicine, especially after Oswaldo Cruz assumed its leadership in 1902. From there on, the institute became the base for memorable sanitation campaigns in an age of outbreaks and epidemics of the bubonic plague, yellow fever, and smallpox.
The Institute, however, was not confined to Rio de Janeiro and, on the contrary, collaborated in the occupation of the country’s interior through scientific expeditions, aiding in the development of the country.
When Oswaldo Cruz died, in 1917, the Institute, which by then already bore his name, was nationally consolidated through important scientific achievements, such as Carlos Chagas’ description of the complete cycle of the American trypanosomiasis including the clinical pattern of the disease.
On 16 January 2007, the Institute announced that it had developed a gel from algae which it is hoped will reduce HIV transmission to women.Today the institution has a broad range of responsibilities related to the health and wellbeing of the Brazilian population. This includes hospital and ambulatory care; health-related research; development of vaccines, drugs, reagents, and diagnostic kits; training of public health and health workers; and providing information and communications related to health, science, and technology. The Fiocruz workforce members are over 7,500. Fiocruz includes several fixed facilities in Rio de Janeiro and other locations; however, it contributes to improving health throughout the country, through its support to the Sistema Único de Saúde (Unified Health System, the Brazilian public health system), its proposals on public health policy-making, its research activities, its scientific expeditions, and the reach of its health services and products.
Fiocruz is one of the founding members of the International Association of National Public Health Institutes, a membership organization of national public health institutes.Plague (disease)
Plague is an infectious disease caused by the bacterium Yersinia pestis. Symptoms include fever, weakness and headache. Usually this begins one to seven days after exposure. In the bubonic form there is also swelling of lymph nodes, while in the septicemic form tissues may turn black and die, and in the pneumonic form shortness of breath, cough and chest pain may occur.Bubonic and septicemic plague is generally spread by flea bites or handling an infected animal. The pneumonitic form is generally spread between people through the air via infectious droplets. Diagnosis is typically by finding the bacterium in fluid from a lymph node, blood or sputum.Those at high risk may be vaccinated. Those exposed to a case of pneumonic plague may be treated with preventative medication. If infected, treatment is with antibiotics and supportive care. Typically antibiotics include a combination of gentamicin and a fluoroquinolone. The risk of death with treatment is about 10% while without it is about 70%.Globally about 600 cases are reported a year. In 2017 the countries with the most cases include the Democratic Republic of the Congo, Madagascar and Peru. In the United States infections occasionally occur in rural areas and the bacteria is believed to circulate among rodents. It has historically occurred in large outbreaks, with the most well known being the Black Death in the 14th century, which resulted in greater than 50 million dead.Plague vaccine
Plague vaccine is a vaccine used against Yersinia pestis. Killed bacteria have been used since 1890 but are less effective against pneumonic plague so that recently live vaccines of an attenuated type and recombination protein vaccines have been developed to prevent the disease.Pneumonic plague
Pneumonic plague is a severe lung infection caused by the bacterium Yersinia pestis. Symptoms include fever, headache, shortness of breath, chest pain, and cough. They typically start about three to seven days after exposure. It is one of three forms of plague, the other two being septicemic plague and bubonic plague.The pneumonic form may occur following an initial bubonic or septicemic plague infection. It may also result from breathing in airborne droplets from another person or cat infected with pneumonic plague. The difference between the forms of plague is the location of infection; in pneumonic plague the infection is in the lungs, in bubonic plague the lymph nodes, and in septicemic plague within the blood. Diagnosis is by testing the blood, sputum, or fluid from a lymph node.While vaccines are being worked on, in most countries they are not yet commercially available. Prevention is by avoiding contact with infected rodents, people, or cats. It is recommended that those infected be isolated from others. Treatment of pneumonic plague is with antibiotics.Plague is present among rodents in Africa, the Americas, and Asia. Pneumonic plague is more serious and less common than bubonic plague. The total reported number of all types of plague in 2013 was 783. Untreated pneumonic plague has a mortality of nearly 100%. Some hypothesize that the pneumonic version of the plague was mainly responsible for the Black Death that resulted in approximately 50 million deaths in the 1300s.San Francisco plague of 1900–1904
The San Francisco plague of 1900–1904 was an epidemic of bubonic plague centered on San Francisco's Chinatown. It was the first plague epidemic in the continental United States. The epidemic was recognized by medical authorities in March 1900, but its existence was denied for more than two years by California's Governor Henry Gage. His denial was based on business reasons, to protect the reputations of San Francisco and California and to prevent the loss of revenue due to quarantine. The failure to act quickly may have allowed the disease to establish itself among local animal populations. Federal authorities worked to prove that there was a major health problem, and they isolated the affected area; this undermined the credibility of Gage, and he lost the governorship in the 1902 elections. The new Governor George Pardee implemented a medical solution and the epidemic was stopped in 1904. There were 121 cases identified, including 119 deaths.Much of urban San Francisco was destroyed by fire in the 1906 San Francisco earthquake, including all of the Chinatown district. The process of rebuilding began immediately but took several years. While reconstruction was in full swing, a second plague epidemic hit San Francisco in May and August 1907 but it was not centered in Chinatown. Cases occurred randomly throughout the city, including cases identified across the bay in Oakland. San Francisco's politicians and press reacted very differently this time, wanting the problem to be solved speedily. Health authorities worked quickly to assess and eradicate the disease. Approximately $2 million was spent between 1907 and 1911 to kill as many rats as possible in the city in order to control one of the disease's vectors.In June 1908, 160 more cases had been identified, including 78 deaths, a much lower mortality rate than 1900–1904. All of the infected people were Caucasian, and the California ground squirrel was identified as another vector of the disease. The initial denial of the 1900 infection may have allowed the pathogen to gain its first toehold in America, from which it spread sporadically to other states in the form of sylvatic plague (rural plague). However, it is possible that the ground squirrel infection predated 1900.Spotted fever
A spotted fever is a type of tick-borne disease which presents on the skin. They are all caused by bacteria of the genus Rickettsia. Typhus is a group of similar diseases also caused by Rickettsia bacteria, but spotted fevers and typhus are different clinical entities.
The phrase apparently originated in Spain in the 17th century and was ‘loosely applied in England to typhus or any fever involving petechial eruptions.’ During the 17th and 18th centuries, it was thought to be "cousin-germane" to and herald of the bubonic plague’, a disease which periodically afflicted the city of London and its environs during the 16th and 17th centuries, most notably during the Great Plague of 1665.Types of spotted fevers include:
Mediterranean spotted fever
Rocky Mountain spotted fever
Queensland tick typhus
Helvetica spotted feverTheories of the Black Death
Theories of the Black Death are a variety of explanations that have been advanced to explain the nature and transmission of the Black Death (1347–51). A number of epidemiologists and since the 1980s have challenged the traditional view that the Black Death was caused by plague based on the type and spread of the disease. The confirmation in 2010 and 2011 that Yersinia pestis DNA was associated with a large number of plague sites has renewed focus on plague as the leading hypothesis, but has not yet led to a final resolution of all these questions.Third plague pandemic
Third Pandemic is the designation of a major bubonic plague pandemic that began in Yunnan province in China in 1855. This episode of bubonic plague spread to all inhabited continents, and ultimately more than 12 million people died in India and China, with 10 million people killed in India alone. According to the World Health Organization, the pandemic was considered active until 1960, when worldwide casualties dropped to 200 per year.The name refers to this pandemic being the third major bubonic plague outbreak to affect European society. The first was the Plague of Justinian, which ravaged the Byzantine Empire and surrounding areas in 541 and 542. The second was the Black Death, which killed at least one third of Europe's population in a series of expanding waves of infection from 1346 to 1353.Casualty patterns indicate that waves of this late-19th-century/early-20th-century pandemic may have been from two different sources. The first was primarily bubonic and was carried around the world through ocean-going trade, through transporting infected persons, rats, and cargoes harboring fleas. The second, more virulent strain, was primarily pneumonic in character with a strong person-to-person contagion. This strain was largely confined to Asia, in particular Manchuria and Mongolia.