Bubonic plague, which became notorious during the 14th Century in Europe and swept through India from the 1890s to 1910s, is caused by bacteria called Yersinia pestis. Contrary to popular belief, this plague isn’t caused by rat bites. The cause of bubonic plague is the bite of infected fleas. These fleas live in the hairs of small mammals like rats, mice, squirrels, voles, chipmunks, etc., which may come in close contact with humans. 

Bubonic plague is a serious disease that requires immediate emergency treatment. Left untreated, it has a mortality rate of 30-60%. 

Recently, a man in Oregon, USA, was diagnosed with bubonic plague. It is believed that he came in contact with an infected flea through his pet cat. 

So what does this mean? Are we looking at a new pandemic? Let’s find out. 

How does the plague spread? 

The danger of plague lies in the fact that it can spread in multiple ways. People can get infected if they-

• Are bitten by fleas infected with the bubonic plague bacteria- Yersinia pestis. 
• Come in contact with the bodily fluid or any contaminated material of a person with plague. 
• Inhale respiratory particles that have been sneezed or coughed out by a person infected with pneumonic plague (involvement of lungs due to spread of plague infection) 

What are the types of plague? 

Most of us think that plague implies bubonic plague. But actually, Yersinia pestis can cause three types of plague- 

1. Bubonic plague– Being bitten by a plague-infected flea or direct contact with an infected person’s bodily fluid causes bubonic plague. Infection spreads to lymph nodes. Bubonic plague is much more common than pneumonic and septicemic plagues. 

2. Pneumonic plague– Inhaling the respiratory droplets of a person infected with pneumonic plague causes pneumonic plague in a healthy person. Bubonic plague may also spread to the lungs, causing pneumonic plague. 

Pneumonic plague is even more fatal than bubonic plague, with a mortality rate of 30-100% if not treated immediately.

3. Septicemic plague- A complication of bubonic or pneumonic plague, which develops when the bacteria multiplies in the blood. It can sometimes result directly from exposure to an infected person or through an infected flea bite. 

Untreated septicemic plague has a mortality rate of 100%.

Symptoms of bubonic plague

Bubonic plague has an incubation period of 2-8 days. That means an infected person will show the symptoms of bubonic plague within nine days of exposure. 

Here are the symptoms of bubonic plague-

• Fever with chills
• Headache
• Muscle aches, especially in the abdomen, arms and legs
• Weakness
• Swollen lymph nodes
• Darkened tissues in the fingers and toes
• Dizziness, Confusion
• Abdominal discomfort

The bacteria travels along the lymphatic system and reaches the lymph nodes. Here, the bacteria start to clone themselves. As a result, the lymph nodes become inflamed and extremely painful to the touch. These swellings are called ‘buboes’ and they fill up with pus. If left untreated, the buboes burst open and appear as sores on the skin. The lymph nodes of the armpits, neck and groin can even enlarge up to the size of an egg.

Without treatment, the bacteria can travel to the lungs and infect them. This triggers pneumonic plague. 

How is bubonic plague detected? 

A diagnostic test is required to know for sure if a person has bubonic plague. A sample of the pus from a bubo may be collected. 

Blood and sputum samples may also be tested. Doctors will advise the lab tests depending on the patient’s clinical condition. 

Bubonic plague medication

Since bubonic plague is caused by bacteria, the treatment of bubonic plague is antibiotics. A person diagnosed with bubonic plague is to be hospitalised immediately and put on antibiotics. The dose and duration will be determined by the doctors. 

Can bubonic plague be prevented? 

The best way to reduce the chances of getting bubonic plague is

1. To clean up our cities and neighbourhoods to prevent the increase in the population of mice, rats and other rodents. 

2. On an individual level, bubonic plague prevention involves owners of small animals not letting their pets roam free in areas with a risk of infection.
3.  Regular veterinary visits for vaccination and treatment of pets are required to prevent and cure flea infestations. 
4. Infected animals and humans should be given prompt treatment and isolation as recommended. 

Is there a vaccine for bubonic plague? 

There is no officially registered or licensed plague vaccine in the market currently. Incidents of plague are too rare today for there to be a vaccine for the common people. 

However, there are some killed whole-cell (KWC) and live attenuated vaccines that are only given to doctors and healthcare providers who work in those very few places of the world where bubonic plague is endemic. 

Can bubonic plague become a pandemic? 

After COVID-19, every report of a less common disease makes people wonder if we are looking at a new health threat. 

Bubonic plague is less likely to become a full-blown pandemic. 

The bubonic plague, which wreaked havoc in Europe in the 14th century and in India in the early 20th Century, was curtailed through strict quarantine. But it never really went away. Even today, 1000-2000 cases of bubonic plague are reported every year, according to WHO. 

There have always been small outbreaks of this disease and the latest one was in China in 2020. 

Unlike the plague pandemics of the past or even the COVID-19 pandemic, scientists and doctors today have clear and undisputed knowledge of bubonic plague, how it is transmitted, its nature and bubonic plague cure. We have antibiotics that can cure the disease. That is why bubonic plague is less likely to become a pandemic and can easily be halted from spreading every time cases are reported. 

Conclusion

There are many bacteria and viruses out there that can cause any number of diseases and as common people, we have very little control over what happens. 

But what we can do is take care of our bodies through a wholesome diet, healthcare supplements if needed and regular exercise. Lifestyle diseases such as type 2 diabetes, hypertension, high levels of cholesterol, triglycerides, etc, should be managed because these become comorbidities of other diseases and make them more dangerous. 

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References

1. https://www.who.int/news-room/fact-sheets/detail/plague
2. https://www.cdc.gov/plague/faq/index.html#:~:text=Plague%20has%20occurred%20in%20people,number%20is%20likely%20much%20higher.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6804290/#:~:text=In%20the%20case%20of%20plague,that%20we%20are%20aware%20of.
4. https://www.cdc.gov/plague/faq/index.html#:~:text=Plague%20has%20occurred%20in%20people,number%20is%20likely%20much%20higher
5. https://www.healthline.com/health-news/seriously-dont-worry-about-the-plague
6. https://my.clevelandclinic.org/health/diseases/21590-bubonic-plague
7. https://www.pbs.org/wgbh/rxforsurvival/series/diseases/plague.html#:~:text=Mortality%20rates%20for%20treated%20individuals,and%20100%20percent%20for%20septicemic
8. https://www.who.int/news-room/fact-sheets/detail/plague
9. https://www.who.int/news-room/fact-sheets/detail/plague#:~:text=Plague%20can%20be%20a%20very,early%20treatment%20can%20save%20lives