Although the plague no longer occurs in Germany today, almost everyone is familiar with it because of its history. In particular, the plague epidemics of the Middle Ages stuck in people’s minds. However, isolated cases of the subtype pneumonic plague still occur in some countries. Check with your doctor if necessary.
What is plague?
Plague is a disease caused by the bacterium Yersinia pestis, which occurs in four different manifestations: bubonic, pulmonary or abortive plague and plague sepsis. Plague meningitis occurs less frequently when the plague pathogens attack the meninges. Most people know the plague as the Black Death of the Middle Ages – it is now widely accepted that the historically documented waves of plague are actually attributable to the pathogen Yersinia pestis. However, most forms are treatable these days. See AbbreviationFinder for abbreviations related to Plague.
The causative agent of plague is a zoonotic disease, a disease transmitted by animals. Rats are the best-known carriers, but squirrels, marmots and similar rodents can also be dangerous. Yersinia pestis is not transmitted directly by the rodent itself, but through the bite of its fleas. The bubonic plague is usually caused by such a flea bite and develops a few hours to seven days later. It is accompanied by severe drowsiness, fever, and purulent or blue-colored swelling of the lymph nodes.
This can result in plague sepsis, in which the bacteria penetrate the bloodstream, release toxins (poisons), die and cause death after 36 hours at the latest through internal and external bleeding. But it can also lead to abortive plague through the flea bite – only a slight fever and feeling of illness appear, after which the patient is immune to all pathogens. Pneumonic plague, on the other hand, in which Yersinia pestis attacks the lungs, is still extremely dangerous today.
Symptoms, Ailments & Signs
In about 90 percent of cases of infection with the plague pathogen, the symptoms of bubonic plague appear. The first symptoms appear about two to six days after infection. Those affected suffer from high fever, chills, headaches, body aches and a very strong feeling of illness.
The bumps (buboes) that give bubonic plague its name develop as a result of infected and inflamed lymph nodes. They swell up and hurt. Due to the infection, there is severe suppuration, which eventually leads to the disintegration of the inflamed lymph nodes. These can also break open to the outside – through the skin.
Other symptoms follow as the inflamed lymphatic vessels and nodes infect the circulatory system. This can lead to sepsis. If Yersinia pestis reaches the lungs, it causes pneumonic plague with shortness of breath and bloody sputum. The symptoms of plague sepsis, on the other hand, can affect the entire body.
Various organs become infected, skin bleeds, digestive problems, extreme exhaustion and shock reactions. Plague sepsis is a symptom that is to be expected in the course of an untreated plague infection. Plague sepsis is almost always fatal. In rare cases, the plague can also show very mild symptoms that are hardly dangerous.
Diagnosis & course of disease
Almost every form of the plague begins with a fever and even chills, a general feeling of illness and drowsiness. The incubation period is a few hours up to 7 days, with pneumonic plague 1-3 days. To distinguish the form of plague, attention must be paid to the specific symptoms. In the case of bubonic plague, for example, these are the swollen lymph nodes that turn yellow to blue with pus.
Shortness of breath, black bloody sputum and pulmonary edema are characteristic. A plague sepsis can result from both forms or bring about the pneumonic plague, which is why it must also be recognized. It manifests itself through an increase in the general symptoms of the disease, headaches can also occur. Only the abortive plague is quite harmless: At best, it can recede on its own after it has shown mild, non-specific symptoms.
The extent of the plague depends on the form it takes. The symptoms of abortive plague are relatively minor. With other forms, however, there is a risk of serious complications. The risk is particularly high if there is no medical treatment for the plague.
One complication that can arise from bubonic plague is pneumonic plague. In this case, doctors speak of secondary pneumonic plague, since the more common primary form is transmitted by droplet infection. Pneumonic plague takes a rapid course and sometimes shows up after just a few hours. However, secondary pneumonic plague progresses more slowly than the primary form.
Typical signs are exhaustion, chills, fever, headache, muscle pain and dizziness. On the second day of the illness, there is a cough with black and bloody sputum, chest pains, breathing difficulties and a blue discoloration of the skin. Abdominal pain, diarrhea, nausea and vomiting are not uncommon.
Just like bubonic plague, skin plague, plague meningitis or plague laryngitis, pneumonic plague can develop into a life-threatening plague sepsis. In about ten percent of all plague patients, the plague bacteria penetrate into the blood, where they cause blood poisoning. The plague sepsis is noticeable through lethargy, high fever, digestive problems and a drop in blood pressure.
In addition, the patient reacts confused. Furthermore, plague sepsis can cause vascular occlusions that affect the blood supply to the organs. In extreme cases, the patient dies.
When should you go to the doctor?
The plague is one of the diseases that have not occurred in Germany for a long time. Nevertheless, a doctor’s visit is advisable if the person concerned is convinced that he is suffering from this deadly disease. Headaches and body aches, a very high body temperature and a feeling of being ill are signs of an irregularity that should be investigated. If there are other flu-like symptoms such as chills, exhaustion and tiredness, a doctor’s visit is recommended.
There is a need for action in the event of discolouration of the skin, suppuration and swelling of the lymph glands. Sepsis can occur. This creates a life-threatening condition. Shortness of breath, bleeding from the skin and bloody sputum must be examined and treated as soon as possible. If there is an increase in the existing symptoms, the person concerned needs help immediately. In the case of disturbances of consciousness or a state of shock, an emergency service must be alerted. Since the plague is a highly contagious disease, the instructions of the emergency doctor should be followed.
If left untreated, the disease can spread quickly and infect countless people. In addition, there is a potential danger to life for the patient, since the course of the disease ends fatally within a short time without medical care.
Treatment & Therapy
The pathogen Yersinia pestis is a bacterium, which is why the basis of treatment for plague is based on antibiotics. The drug of choice is streptomycin, which is administered intramuscularly while the patient is under hospital surveillance. Rapid treatment is particularly important for pneumonic plague, as it still has an extremely high mortality rate today.
If streptomycin cannot be used or the effect has to be felt very quickly in order to be able to help the patient, chloramphenicol is used instead, which, however, is considered the last treatment option. It is known for its powerful side effect, aplastic anemia. Although this only occurs in one in 6000-36000 cases, it is a risk that should not be underestimated, especially with the plague. Depending on the severity of the symptoms, these are also treated – high fever, for example, can be reduced, pain can be relieved with medication.
After contracting the plague, patients are usually immune to reinfection. There is also no need for long-term treatment and everyday support. The symptoms subside completely. The affected person returns to his everyday life. Aftercare measures are mainly related to the protection of other people.
The easy transmission of the plague led to the death of entire areas in the Middle Ages. Patients with an established illness must remain in isolation for several days after the end of the symptoms. A blood test gives a conclusion as to whether the pathogen is still in the organism.
The best follow-up strategy is to avoid sick people and animals. Patients are responsible for this themselves. Anyone traveling to risk areas can be vaccinated against certain pathogens. However, the active substance only provides immunity for a short time.
Unlike cancer, the plague cannot be caused by a new formation from the body itself. The isolation of sick people described above is the most effective means of preventing infection. In the event of an outbreak of plague in Europe, state authorities will ensure quarantine. Patients must follow the instructions of the medical staff.
Outlook & Forecast
In contrast to earlier times, such as the Middle Ages, when the plague depopulated entire regions, the prognosis for the infectious disease is more favorable today. However, the prospects today also depend on the course of the disease and whether it is treated in good time. If, for example, it is an abortive plague, the plague is mild and the prognosis is positive. The body’s defense system produces antibodies that ensure long-lasting immunity.
If the patient suffers from bubonic plague and this is treated at the right time, the chances of recovery are good and the affected people survive the serious illness. However, if treatment with antibiotics is not provided in good time, between 50 and 60 percent of those affected die. The drugs must be administered after about 15 hours at the latest.
The prognosis is particularly unfavorable when forms of plague such as pneumonic plague or plague sepsis are present. Patients often do not receive rescue therapy in time. However, if the diagnosis is made early and the plague is treated with antibiotics, the mortality rate for both pneumonic plague and plague sepsis is reduced by about 15 percent.
Normally, if the affected person survives the disease, they have substantial immunity to the plague. In some patients, however, later outbreaks of plague appear again.
You can do that yourself
The plague is considered to be a disease that has been eradicated in Germany. Due to changed hygienic conditions in the last hundred years as well as medical progress, the plague is only known to current generations through historical records. Nevertheless, caution should always be exercised when dealing with wild animals.
Direct skin contact with squirrels or rodents of any kind should be avoided in the wild. Rats in particular can transmit the disease-causing bacteria. Since the plague is a life-threatening disease, a doctor should be consulted at the first signs and symptoms. Independent treatment or taking self-determined measures to alleviate the symptoms is not advisable. The treating physicians should be fully informed about the cause and course of the transmission. The plague is a notifiable disease that is treated by medical specialists.
In a very unlikely case of illness, the doctor’s instructions must always be followed so that your own state of health can improve quickly and no further complications arise. Since the risk of infection is very high, handling and physical contact with other people should be avoided. The patient is placed in a quarantine station so that the pathogen cannot spread further in the population.