Plague

Bubonic plague is an often fulminant systemic zoonosis, caused by Yersinia pestis. Conventional microbiology, bacterial population genetics, and genome sequence data, all suggest that Y pestis is a recently evolved clone of the enteric pathogen Yersinia pseudotuberculosis. The genetic basis of this organism's rapid adaptation to its insect vector (the flea) with transmission between mammalian hosts by novel subcutaneous and pneumonic routes of infection is becoming clearer. This transition provides a paradigm for the way in which new pathogens could emerge. Plague in humans is controlled by suppression of rodent reservoir hosts and their fleas and by early detection and treatment of cases of disease. Detection systems for plague in non-endemic regions might now be needed because of a bioterrorism threat. Rapid diagnostic tests are available and a subunit vaccine is in clinical trials.     

Plague

In the United States, plague poses a threat to humans from the infected animals in the endemic areas of the Western states. Plague may also be used in the near future as an agent of warfare or terrorism. Although the presentation of bubonic plague may be less of a problem, the septicemic and pneumonic forms present challenges to early diagnosis and prompt treatment. The major threat of plague as an agent of terrorism will probably be through the inhalational route. which could result in many cases of the pneumonic form, requiring early recognition and initiation of appropriate therapy. In a mass-casualty scenario, the clinician should be aware of the potential agents of biowarfare and be familiar with the treatment and prophylaxis recommendations outlined by the CDC. It is also prudent to employ universal precautions and respiratory isolation when treating patients with any unknown exposure. In endemic areas, personal protective measures such as use of insecticides, insect repellants, and prompt prophylaxis in cases of exposure to plague are recommended for reducing the incidence of infection. The author also recommends review of CDC website on bioterrorism (http://www.bt.cdc.gov) to keep informed of plague updates.     

Plague Pneumonia

Yersinia pestis is a gram-negative bacillus that can cause pneumonia if inhaled. Secondary person-to-person spread of infection can develop. Aerosolization of this organism as a weapon of biological terror could potentially cause many thousands of casualties, mass social disruption, and widespread fear. Plague pneumonia is treatable if recognized early but still carries a 50% to 60% mortality rate. Delay in therapy is associated with 100% mortality rates. Prophylaxis of exposed persons with oral antibiotics is indicated. There is no protective vaccine currently available.     

Plague and tularemia

Human plague is a local or systemic flea-transmitted infection caused by Yersinia pestis. It is maintained in well established enzootic foci among wild rodents. This article discusses the clinical findings in plague, diagnosis, treatment, and prevention of plague, and management of contacts of human plague cases and of exposures to epizootic plague. Tularemia shares many features with plague but is widespread in animal and arthropod vector populations and essentially throughout the United States.     

Plague and glasnost

Summary In October 1989 the first case of plague death in the USSR was reported to WHO. This occurrence in man did not surprise plague experts. The country has extensive enzootic areas and the persistence of natural foci, which can be silent for many years, has been well studied. It is known that the plague bacillus can survive and multiply in the soil of rodent burrows and restart local or more extensive transmissions in carrier animals. Isolated cases in man can remain accidental or they may signal a larger epizootic outbreak. The official policy of the comprehensive antiplague services was to eradicate the natural foci by antirodent activities which proved impossible. The present report from the Central Asian part of the USSR in the wake of Glasnost augurs well for the surveillance of plague worldwide as for a period of over fifty years the occurrence of cases in man in this country had been denied.

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Pest und Glasnost

Zusammenfassung Im Oktober 1989 wurde der WHO aus der USSR der erste Todesfall infolge von Pest berichtet. Dieser Fall hat die Pestexperten nicht überrascht, da es im Lande extensive enzootische Gebiete gibt. Das Bestehen von natürlichen Herden, welche sich über viele Jahre ruhig verhalten, ist gründlich untersucht worden. Es ist bekannt, daß der Pestbazillus in der Erdschicht von Nagernestern überlebt und das Wiederaufflammen von lokalen oder größeren Epizootien zwischen den Trägertieren initiieren kann. Isolierte oder sporadische Pestfälle können vereinzelt bleiben oder den Beginn eines größeren epizootischen Ausbruches signalisieren. Die offizielle Politik der Anti-Pest-Dienste war für viele Jahre, die Nagetiere in den natürlichen Foci auszurotten, was sich jedoch als unmöglich erwies. Dieser Bericht aus dem zentralasiatischen Teil der USSR (eine Folge der Glasnost) ist ein gutes Vorzeichen für die weltweite Pestüberwachung, da behauptet wurde, daß es in den letzten 50 Jahren keine Pestfälle bei Menschen in diesem Lande mehr gab.

     

Plague in Vienna

The history of plague in one city--Vienna, Austria--has been traced from records beginning in the fourteenth century until its disappearance in the eighteenth century. Much of the source material for this review is published for the first time in English and is drawn from records maintained by the city of Vienna at the time of each outbreak. The historical context illustrates the reaction of large populations to deadly disease: fear, helplessness, and acceptance of an ever present threat. Concepts of prophylaxis to ward off the infection were haphazard, empiric, and often dependent on the use of medicaments and treatments that were, in modern terms, irrational. The medical and hygienic concepts of the time were principal impediments to more successful control, as is demonstrated by quotations from official documents dealing with attempts to cope with the epidemic. The development of control measures was painfully slow, and ultimate control was not achieved until socioeconomic improvement and concepts of hygiene both reached the point at which the conditions for the spread of the disease could be minimized.     

鼠疫信息系统在鼠疫细菌学监测数据分析中的应用

目的探讨将鼠疫监测数据直观地表现于地图上的实际意义,为监测数据的分析提供新方法。方法将鼠疫细菌学监测结果整理成Excel（Access）表格,利用鼠疫信息系统数字地图V1.0软件进行专题分析。结果通过PM IS数字地图的数据导入功能,将疫源地基本信息、染疫动物及媒介检菌分布情况完整的显示在地图上。结论该系统的应用可为专业人员对监测数据的分析提供便利,为管理层提供一定的决策支持。     

云南省耿马县鼠疫疫源地及人间鼠疫调查报告

1990年12月11日～31日,对云南省耿马县首次鼠疫流行进行了现场调查。用血清学及细菌学方法在33个疫点(180km~2)检出了63例腺鼠疫患者和13例隐性感染者,并从人,鼠、蚤分离到49株鼠疫菌。造成鼠间鼠疫流行,主要是黄胸鼠数量及印鼠客蚤指数的急骤增高;人间鼠疫是由于鼠间鼠疫长期流行,地面游离蚤增加,人与蚤类接触频繁所致。结果表明:耿马县以勐撒镇为中心的鼠间及人间鼠疫大面积流行是一次典型的家鼠型鼠疫,其疫源地具有西南山地黄胸鼠鼠疫疫源地的特征。鼠疫在该县(至少在动物间)有可能长期存在。     

鼠疫误诊1例

本文报告鼠疫误诊死亡病例1例。经尸体剖检、血清学和细菌学检验、流行病学调查确诊后按照人间鼠疫疫区处理标准及原则（GB15978—1995）进行处理。     

The Plague Doctor of Venice

There is a distinctive Venetian carnival mask with sinister overtones and historical significance to physicians because it belongs to the ‘Doctor of the Plague’. The costume features a beaked white mask, black hat and waxed gown. This was worn by mediaeval Plague Doctors as protection according to the Miasma Theory of disease propagation. The plague (or Black Death), ravaged Europe over several centuries with each pandemic leaving millions of people dead. The cause of the contagion was not known, nor was there a cure, which added to the widespread desperation and fear. Venice was a major seaport, and each visitation of the plague (beginning in 1348) devastated the local population. In response, Venetians were among the first to establish the principles of quarantine and ‘Lazarets’ which we still use today. Plague outbreaks have occurred in Australia, notably in Sydney (1900–1925), and continue to flare up in poorer communities, most recently in Madagascar (2017). Antibiotics are the mainstay of treatment, but there are concerns regarding the emergence of resistant pathogenic strains of Yersinia pestis, and their potential use in bio‐terrorism.