Affects: Cats
Plague is an infectious disease caused by the bacterium Yersinia pestis. Symptoms include fever, weakness, headache and black lips. Usually, this begins one to seven days after exposure. There are three forms of plague, each affecting a different part of the body and causing associated symptoms. Pneumonic plague infects the lungs, causing shortness of breath, coughing and chest pain; bubonic plague affects the lymph nodes, making them swell; and septicemic plague infects the blood and can cause tissues to turn black and die.
The bubonic and septicemic forms are generally spread by flea bites or handling an infected animal, whereas pneumonic plague is generally spread between people through the air via infectious droplets. Diagnosis is typically made by finding the bacterium in fluid from a lymph node, blood or sputum.
Vaccination is recommended only for people at high risk of exposure to plague. Those exposed to a case of pneumonic plague may be treated with preventive 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%.
Signs And Symptoms: There are several different clinical manifestations of plague. The most common form is bubonic plague, followed by septicemic and pneumonic plague. Other clinical manifestations include plague meningitis, plague pharyngitis, and ocular plague. General symptoms of plague include fever, chills, headaches, and nausea. Many people experience swelling in their lymph nodes if they have bubonic plague. For those with pneumonic plague, symptoms may (or may not) include a cough, pain in the chest, and haemoptysis.
Cause: Transmission of Y. pestis to an uninfected individual is possible by any of the following means:
droplet contact – coughing or sneezing on another person
direct physical contact – touching an infected person, including sexual contact
indirect contact – usually by touching soil contamination or a contaminated surface
Diagnosis: Symptoms of plague are usually non-specific, necessitating laboratory testing to definitively diagnose the disease. Y. pestis can be identified through both a microscope and by culturing a sample and this is used as a reference standard to confirm that a person has a case of plague. The sample can be obtained from the blood, mucus (sputum), or aspirate extracted from inflamed lymph nodes (buboes). If a person is administered antibiotics before a sample is taken or if there is a delay in transporting the person's sample to a laboratory and/or a poorly stored sample, there is a possibility for false negative results.
Polymerase chain reaction (PCR) may also be used to diagnose plague, by detecting the presence of bacterial genes such as the pla gene (plasmogen activator) and caf1 gene, (F1 capsule antigen). PCR testing requires a very small sample and is effective for both alive and dead bacteria. For this reason, if a person receives antibiotics before a sample is collected for laboratory testing, they may have a false negative culture and a positive PCR result.
Blood tests to detect antibodies against Y. pestis can also be used to diagnose plague, however, this requires taking blood samples at different periods to detect differences between the acute and convalescent phases of F1 antibody titres.
Treatments: If diagnosed in time, the various forms of plague are usually highly responsive to antibiotic therapy. The antibiotics often used are streptomycin, chloramphenicol and tetracycline. Amongst the newer generation of antibiotics, gentamicin and doxycycline have proven effective in monotherapeutic treatment of plague. Guidelines on treatment and prophylaxis of plague were published by the Centers for Disease Control and Prevention in 2021.
The plague bacterium could develop drug resistance and again become a major health threat. One case of a drug-resistant form of the bacterium was found in Madagascar in 1995. Further outbreaks in Madagascar were reported in November 2014 and October 2017.
Vaccination: Bacteriologist Waldemar Haffkine developed the first plague vaccine in 1897. He conducted a massive inoculation program in British India, and it is estimated that 26 million doses of Haffkine's anti-plague vaccine were sent out from Bombay between 1897 and 1925, reducing the plague mortality by 50–85%.
Since human plague is rare in most parts of the world as of 2023, routine vaccination is not needed other than for those at particularly high risk of exposure, nor for people living in areas with enzootic plague, meaning it occurs at regular, predictable rates in populations and specific areas, such as the western United States. It is not even indicated for most travellers to countries with known recent reported cases, particularly if their travel is limited to urban areas with modern hotels. The United States CDC thus only recommends vaccination for (1) all laboratory and field personnel who are working with Y. pestis organisms resistant to antimicrobials: (2) people engaged in aerosol experiments with Y. pestis; and (3) people engaged in field operations in areas with enzootic plague where preventing exposure is not possible (such as some disaster areas). A systematic review by the Cochrane Collaboration found no studies of sufficient quality to make any statement on the efficacy of the vaccine.
Prophylaxis: Pre-exposure prophylaxis for first responders and health care providers who will care for patients with pneumonic plague is not considered necessary as long as standard and droplet precautions can be maintained. In cases of surgical mask shortages, patient overcrowding, poor ventilation in hospital wards, or other crises, pre-exposure prophylaxis might be warranted if sufficient supplies of antimicrobials are available.