LEGAL
NOTICE: All information on these pages is your choice as
to response. Steve
Van Nattan is not any kind of an authority
on anything for anyone.
PLAGUE AND ITS CURE
Saddam Hussein has been
producing plague germ stockpiles
in Iraq as well as in a plant in Sudan he
built for the
Sudanese Fanatical Muslim Government.
This IS one
disease we must prepare for. PLAGUE--
(bubonic plague, pneumonic plague) What is plague?
Plague is a serious illness caused by bacteria called Yersinia pestis.
The disease is carried by rodents (i.e., rats and mice) and their fleas, which
can then transmit the disease to humans as well as to other animals. Plague is
very rare in the United States, but cases are still reported in the southwestern
states of New Mexico, Arizona, Colorado, Nevada, and California. The most common
form of plague is bubonic plague which affects the body's lymph nodes. When the
infection involves the lungs, the disease is called pneumonic plague.
How do you get it? You can get plague from the bite of infected
fleas or by a scratch or bite while handling infected animals. You can also get
it by breathing in airborne droplets from people who have the plague infection
in their lungs or from infected household pets. Editor: Balaam's
Ass Speaks-- The problem in germ warfare is that the plague is distributed
on the wind and inhaled. This gets it into the blood and lungs, and the
progress of the disease is more rapid. Thus, the drug cures must be ON HAND, and
they must be started at once as symptoms appear. What are the symptoms
of plague? The first symptoms of bubonic plague include the sudden
onset of fever with painful swelling of the lymph nodes, called bubos in the areas
closest to the flea bite (typically, in the groin, armpit, or neck). Chills, muscle-aches,
weakness, fatigue, nausea, and headache may also occur. If the infection spreads
to the lungs, it produces pneumonia that is highly contagious and often, fata.
Pneumonic plague is characterized by fever, swelling of the lymph nodes, cough,
chest pain, and frequently, blood in the saliva. When do symptoms
start? The symptoms of plague begin 1 to 7 days following the bite
of an infected flea. What is the treatment for plague?
Antibiotics can be prescribed by a doctor to treat plague. It is extremely important
to detect and treat the disease early in its course. If left untreated, about
half of those with bubonic plague will die. Prompt treatment can reduce the case
fatality to less than 5%. Persons who are infected with pneumonic plague should
be quarantined for 3 full days of medical therapy. How do you keep
from getting it? Avoid rat-infested areas if possible. If you go to
areas where plague is endemic (an ongoing problem), take precautions to protect
yourself against rodents and their fleas. Avoid contact with sick
or dead animals found on the roadside or in the woods. The risk of being bitten
by infected fleas is high when plague infection kills large numbers of rodents.
The infected and starving fleas aggressively look for new hosts. Carefully
supervise the activities of all children and household pets (i.e., dogs and cats)
when outdoors in forest/picnic areas where rodents make their nests.
International travelers to a plague-endemic area (areas reported to have an ongoing
plague problem) are generally at low risk for infection for Y. pestis. If you
are travelling to a plague endemic area call your doctor or the Health Department
for advice. Report all suspected plague cases promptly to your doctor
or to the Department of Health. "Return to Navigating the Communicable
Diseases - Table of Contents"
I OFFER A SECOND AND RATHER
INTERSETING PRESENTATION: Authored by Demetres Velendzas, MD,
Emergency Medicine, Department of Traumatology & Emergency Medicine, University
of Connecticut Health Center and Susan Dufel, MD, FACEP, Residency Director, Associate
Professor of Emergency Medicine, Department of Traumatology & Emergency Medicine,
University of Connecticut Medical Center _________________
Background: The plague has caused more fear and terror
than perhaps any other infectious disease in the history of mankind. It has laid
claim to nearly 200 million lives and has brought about monumental changes such
as the end of the Dark Ages and the advancement of clinical research in medicine.
Although it is still debated by historians, the plague has been responsible for
three great pandemics in history. The first spread from the Middle East to the
Mediteranean basin during the 5th and 6th century AD, killing approximately 50%
of the population in these areas. The second pandemic afflicted Europe
between the 8th and 14th century wiping out nearly 40% of the population of Europe.
The 3rd pandemic started around 1855 in China and spread to every major continent.
It was during this pandemic in 1894 that Alexandre Yersin isolated the plague
bacillus, developed an antiserum to combat the disease, and postulated its connnection
with fleas and rats. The plague bacillus was named Yersinia Pestis
in his commemoration. These pandemics have suceeded in entrenching the plague
in every major continent, with the possible exception of Australia. Unlike smallpox,
the plague will never be eradicated. It lives in millions of animals and on billions
of fleas that reside on them. It is a disease of the desert, the steppes, the
mountain, and the forest. The epidemic in India in October of 1994, which affected
nearly 600,000 residents, is a reminder of the ease with which the plague can
escape medical control. Pathophysiology:
The exact pathophysiology of the plague is unknown. The etiologic agent is Yersinia
Pestis, an aerobic, facultatively anaerobic, intracellular gram negative bacillus.
The organism can be transmitted from a host to a human via the bite of a
vector. There are more than 200 different rodents and species that can serve as
hosts. These include domestic cats, dogs, squirrels, chipmunks, marmots, deer
mice, rabbits, hares, rock squirrels, camels, and sheep. The vector
is usually the rat flea, Xenopsylla Cheopis. Thirty different species have been
identified as able to carry the plague bacillus, however, including ticks and
human louses. Rodents that are resistant to the infection form an enzootic stage
that assures the long term survival of the bacillus. Occasionally, the infected
animals are not resistant to the disease and die. This is known as an epizootic
stage and it ensures the spread of the organism to new territory. A sylvatic stage
occurs when humans are infected from wild animals. Transmission is not only vector
mediated, but may occur via inhalation of aerosilized bacilli or
close contact with infected tissue or fluid. The bacillus proliferates
in the fleas esophagus preventing food entry into the stomach. To overcome starvation,
the flea begins a blood sucking rampage. Between its attempts to swallow, the
distended bacillus - packed esophagus recoils, depositing the bacillus into the
victims skin. The bacillus invades nearby lymphoid tissue producing the famous
bubo - an inflamed, necrotic, and hemorrhagic lymph node. Spread occurs
along the lymphatic channels towards the thoracic duct with the eventual seeding
of the vasculature. Bacteremia and septicemia ensue. The bacillus potentially
seeds every organ including the lungs, liver, spleen, kidney, and rarely the meninges.
Direct inhalation of the bacillus results in pneumonic plague and subsequent bacteremia
and septicemia. The bacillus causes a multilobar hemorrhagic and necrotizing bronchopneumonia.
The third type of plague is primary septicemic plague. It is hypothesized
that this occurs when the bacillus is deposited early in the vasculature bypassing
the lymphatics. There is early dissemination with sepsis without the formation
of a bubo. This is usually seen in bites to the oral, tonsillar, and pharyngeal
area and is believed to occur because of the short lymphatic distance to the thoracic
duct. Frequency: In the U.S.: An
average of 18 cases per year have been reported during the last few decades. The
prairie dog repopulation of the southwestern plains that had been depleted by
an epizootic stage is nearly complete. There is some evidence to suggest that
a new epizootic stage is begining with higher sylvatic infections being reported
since 1992. West of the 100th parallel, in states like New Mexico, Arizona, Colorado,
Utah, and California there exists one of the largest animal foci of the plague
worldwide. It is of note that only one case of imported plague has been reported
since 1926. Internationally: Between 1967 and 1993 there have been
annually an average of 1,666 cases of the plague reported by the World Health
Organization. The number of actual cases is probably much higher given the failure
of many countries to diagnose and report the plague. In decreasing order the following
countries reported the most cases of the plague since 1979: Tanzania, Vietnam,
Zaire, Peru, Madagascar, Burma, Brazil, Uganda, China, and the United States.
Mortality/Morbidity: Bubonic Plague
has 1-15% mortality in treated cases and a 40 - 60% mortality in untreated cases.
Septicemic plague (either primary or secondary) has 40% mortality in treated
cases and a 100% mortality in untreated cases. Pneumonic plague (either
primary or secondary) has a 100% mortality if not treated within the first 24
hours of infection. Sex: Greater
than 50% of cases occur in males. Age:
Approximately 50% of cases occur in persons less than 20 years of age.
History: Recent travel in the southwestern and pacific
coast regions of the United States, particularly in New Mexico, Arizona, California,
and Utah should raise suspicion of a flea bite. Although imported plague is rare,
similar suspicion should exist for any recent travel in endemic areas outside
the US. Close contact with any potentially infected host or rural
environment should raise suspicion for the plague. Although historically the rat
has been thought to be the main plague host, currently in the United States, the
ground and rock squirrel are the most common hosts. It is also noteworthy that
in recent years the domestic cat has emerged as a prominent host that transmits
the plague to veterinarians. Fever, chills, body aches, sore throat,
headache, and weakness. Enlarged, painful, swollen "node"
Abdominal pain, nausea, vomiting (bloody at times), constipation or diarrhea,
black or tarry stools. It is noteworthy that gastrointestinal complaints may precede
the development of a bubo. Cough which may be productive of bloody
sputum. Shortness of breath Stiff neck (if meningitic
infiltration by the plague bacillus has occurred) Physical:
Temperature of 37 - 40.9 C, tachycardia, tachypnea, hypotension
if in late septic shock. Inguinal bubo (60%), axillary bubo (30%),
cervical (10%), or epitrochlear (10%). Bubo's are usually no greater than 5 cm,
extremely tender and erythematous, and surrounded by a boggy hemorrhagic area.
At the site of the flea bite there may be a maculo - papular lesion.
Other dermatologic findings include vesicles, pustules, skin cyanosis of extremites
(digits, penis, nares), ecchymosis, and petechiae (from DIC). It is thought the
name "black death" originated because of the (black) cyanotic color of the necrotic
limbs of infected individuals. Diffuse crackles, diffuse areas of
dullness to percussion (secondary to the patchy consolidation of pneumonic plague),
hemoptysis Diffuse abdominal tenderness, with or without guarding,
splenomegaly, hematochezia or heme positive stools Nuchal rigidity,
diffuse muscle and joint tenderness Various degrees of mental status
changes, ranging from mild confusion or agitation to delirium and coma
Seizures Bleeding from any body site or cavity, ie. hematemesis,
hematochezia, hemoptysis. Gangrene and necrosis of areas like the
digits, penis, nares. (This is a phenomenon ascribed to peripheral thrombosis
secondary to DIC and cyanosis) TREATMENT:
Prehospital Care: Supportive Care Crystalloid
infusion to maintain normal vital signs and clinical hydration state.
Oxygen administration via nasal cannula, non - rebreather mask, or intubation,
as determined by the respiratory distress of the patient. Pulse oximetry
can be used to monitor the degree of respiratory compromise.
Isolation Precautions Health care personel should assume
universal precautions when dealing with any patient with an infectious diseasepresentation.
This should include goggles, gloves, and gown. If respiratory symptoms are present
masks should be worn. Emergency Department Care:
Supportive care Depending on the stage of presentation
supportive care will vary. Early presentation may only require crystalloid administration
with monitoring of vital signs, clinical state, and urine output. Septic shock
would require invasive hemodynamic monitoring with crystalloid and vasopressor
agents. Airway managment may require intubation and mechanical ventilation with
PEEP. Empiric Antibiotic Coverage (see next section) Strict
Isolation Precautions If respiratory symptoms are present universal
precautions must be instituted with strict respiratory isolation for the first
72 hours of therapy. If no respiratory symptoms are present only 48 hours of isolation
are needed or until there is no purulent drainage by the bubo. All contaminated
material should be incinerated or autoclaved. Consultations:
Infectious Disease Specialist Early notification
of the Centers For Disease Control will allow samples to be sent to the headquarters
in Colorado for diagnosis by fluorscent antibody testing. In addition, the CDC
in conjunction with the Department of Health will attempt to identify the source
of the plague and implement early epidemiologic control measures to control a
potential epidemic. Medical Intensivist In most cases
of the plague some degree of septic shock will be present. Invasive hemodynamic
monitoring and close observation of fluid and cardiac status will require admission
to a Medical Intensive Care Unit. MEDICATION:
Medical management of the Plague can involve a myraid of supportive medications,
including crystalloids, colloids, medications used for intubation, vasopressor
agents, antiulcer, and antipyretic agents. This section will only cover the antibiotic
management of the plague. It is essential that antibiotics be given early, after
samples for diagnostic purposes have been obtained. Drug
Category: Antibiotics - Drugs that cover Y. Pestis should be empirically given
to any patient with predisposing risk factors, signs and symptoms of the plague.
Drug Name: Streptomycin - Streptomycin is the drug of choice
in combination with tetracycline or chloramphenicol. Because of the drugs toxicity
it is usually discontinued after the first five days of treatment and tetracycline
(or chloramphenicol) is continued alone for the remaining course. Streptomycin
is a class D antibiotic for pregnancy. Given the high mortality of the plague,
however, streptomycin and chlorapmhenical are the antibiotics of choice for the
treatment of the plague in a pregnant patient. Adult Dose: 30mg/kg/day
IM divided either bid,tid,or qid Maximum daily dose 2g Pediatric:
20-30mg/kg/day IM divided either bid, tid, or qid Note - newborn infants
with transplacental infection by the plague should receive gentamycin instead.
Contraindications: Contraindicated in a documented aminoglyside hypersensitivity
reaction Interactions: Synergistic toxicity with other ototoxic,nephrotoxic
and peripheral neuromuscula Pregnancy: D - Unsafe in pregnancy
Precautions: Impaired renal funtion ( may need dose adjustment)
______________________ Tetracycline (Sumycin, Tetracyn IV):
Drug of choice for use with streptomycin for the first five days of treatment
(or until the patient is afebrile) and alone for the remaining course.(Marcus
1989) Adult Dose: 15mg/kg (maximum 1g) po loading dose; 40-50mg/kg
po q4 hours day 1; 30mg/kg po q 6hours for a total of 10 - 14 days of therapy;
if oral therapy not tolerated may give IV 5mg/kg iv loading dose; 15mg/kg iv q4hours
day 1; 5mg/kg iv q6hours for the remainding treatment; May switch to po at any
time if patient can tolerate it. Pedistric Dose: If the suspicion
of the plague is high some authors recommend similar dosages and regimens for
all pediatric cases, even children less than 8 years old. Contraindications:
Pregnancy, Children less than 8 years of age Interactions: Other
nephrotoxic and hepatoxic drugs. Pregnancy: D - Unsafe in pregnancy
Precautions: Renal insufficiency, liver disease, use with dairy products
and Fe salts _____________________ Drug Name: Chloramphenicol
(chloromycetin) - Drug of choice to be used instead of tetracycline, in plague
meningitis (better CNS penetrations), profound hypotension, pleural or pericardial
involvement, and in the pregnant patient. Adult Dose: 50 - 100 mg/kg/qd
iv divided q6hours; 30 mg/kg/qd po divided q6 hours may be substituted instead
of iv for the last 5 days of therapy Pediatric: Infant 0-7 days
25 mg/kg po or iv qd; Infant >7 days 50 mg/kg/qd po or iv divided q12 hours
Contraindications: No absolute contraindications. Careful in
pregnancy, with breast- feeding, hepa Interactions: May increase
effects of warfarin, phenytoin, chlorpropamide, and tolbutamide Pregnancy:
C - Safety for use during pregnancy has not been established
Precautions: May cause anemia, aplastic anemia, childhood leukemia,
and grey - baby syndrome ______________________ Drug
Category: Prophylactic antibiotics - This is how to take the drug if Plague is
in the area or you know a terrorist release of the toxin has taken l\place where
you were present. [ Editor: Balaam's Ass Speaks--
If the plague is active in your area in epidemic proportions, I suggest
you take one 500 mg of Tetracycline a day, on an empty stomach, as a
prophylactic. ] All contacts with the bubonic or septicemic plague
should be placed under surveillance. At first sign of illness (fever, adenopathy,
etc.) regular antibiotic treatment should be started. Household contacts of patients
with the bubonic or septicemic plague may have been exposed to the same fleas
so antibiotic prophylaxis is recommended. Prophylaxis is also indicated for all
contacts with patients with the pneumonic plague, ie. emergency department and
EMS personnel. Drug Name: Tetracycline - DOC in adults and children
greater than 8 years of age. Adult Dose: 25 - 50 mg/kg/day po
divided qid Pediatric: 250 mg po qid for 5-10 days
Contraindications: pregnancy, children less than 8 years of age, Interactions:
Dairy products and Fe salts may reduce GI absorption. Pregnancy:
D - Unsafe in pregnancy Precautions: May increase azotemia
in patients with prior renal insufficiency. _____________________
Editor: Balaam's Ass Speaks-- The doctor
has to tell you that the drugs are a problem for pregnant women. If you
know a lady you live has become infected with the plague, you will want to do
one of the following: 1. Contact a doctor and see if you can
get medical help for the lady. IF THAT CANNOT BE DONE DUE TO CHAOS:
2. Start the course and take the risk. The lady will certainly
die if she was infected by breathing in the toxin, and if you do nothing. You
should be aware that the baby could be born with problems though.
Cure of choice if you have no opportunity to follow the details above- Tetracycline--
Double the first two day's doses and then follow normal dosing. 600 mg a
day on empty stomach circa two hours after a meal. Exception is Doxyciline
and Minocycline which can be taken with food. 40 pills of 500 to 600 mg
each should be taken over a maximum of a 10 day period. The Dr. in Mexico
suggested 500 mg every 6 to 8 hours. ______________________________________LINKS: *
* * * *
THE REST OF THE ARTICLES IN THIS
SERIES: SURVIVAL
DURING ATTACKS AND PANIC MORE
COMPLETE DISCUSSION OF PANIC AND BIO ATTACKS RESPONSE
A
DISCUSSION OF BIOLOGICAL WARFARE AND THE USE OF TOXINS
BOTULISM
AS BIOLOGICAL WARFARE AND ITS CURE
PLAGUE
AS BIOLOGICAL WARFARE AND ITS CURE
ANTHRAX
TERRORIST ATTACK AND HOW TO PREVENT AND CURE IT SMALLPOX--
NO CURE-- Prelude to Armageddon
BACK
TO THE TITLE PAGE
graphid
edit | 