Table of Contents
Introduction
Bubonic plague is a bacterial disease caused by the organism
Yersinia pestis. It is transmitted by the bite of an infected
flea, carried by rodents, and has been responsible throughout
history for many epidemics. One of the most famous occurred
in 1348, known as the Black Death, which progressed through
Asia and Western Europe, killing approximation one-third of
the population.
For healthcare providers out there, Yersinia pestis is a
gram negative rod that is acceptable to a variety of antibiotics,
which will be discussed under medical treatment.
In the United States, hosts that carry Yersinia pestis include
the white-footed deer mouse, voles, prairie dogs, as well
as ground squirrels. Western United States has had their fair
share of instances of plague. These states include New Mexico,
Arizona, California, Colorado, Nevada, and Utah. From 1944-1993,
there have been 362 cases of human plague in the United States.
90% of these have occurred in Arizona, California, Colorado
and New Mexico. In 1995, there were 3 cases of plague in New
Mexico and 2 in California, as well as one case in Arizona.
There are 3 different types of plague: bubonic, septicemic
and pneumonic, the most common being bubonic.
Dogs and cats can acquire plague. Dogs usually do not become
very ill. However cats can become very ill and can die from
pneumonic plague, and cats can transmit plague to humans by
their bite.
Bubonic Plague Symptoms
The most common form of pain is bubonic plague, characterized
by buboes, which are large, very tender lymph nodes, which
feel like nodules. These usually form away from the fleabite.
The incubation period is approximately 2-6 days before symptoms
start, and it is not uncommon to have very dark, blackened
lesions that occur on the skin, hence the name “black
death.” Of the 71 cases of plague reported in New Mexico
between 1980 and 1984, 18 were septicemic.
Plague is much more common in individuals less than 40 years
old. This is probably due to greater outdoor activity. The
white-footed deer mouse was thought to be the culprit in these
cases. The white-footed deer mouse is also a common culprit
in the hanta virus.
Bubonic Plague Treatment
Healthcare provider - Medical Treatment
A thorough history is imperative when
contemplating a diagnosis of plague. Does the person hunt?
Have they recently traveled to Western United States or to
another country? Have they done any skinning of animals? Signs
and symptoms if plague is suspected, lymphadenopathy, high
fever, fatigue, tachycardia, tachypnea, and abdominal symptoms,
especially if they have come from an endemic area. Antibiotic
therapy should be started immediately, even before labs are
back.
Diagnosis is based on cultures of the organism
from sputum, transtracheal aspirate, blood or aspirates of
the buboes.
The drug of choice is Streptomycin. However
this should not be given too rapidly. The recommended dose
is 30 mg./kilogram a day intramuscularly, and 4 divided doses
every 6 hours for 5 days. Individuals with renal impairment
should have the dose modified appropriately. Tetracycline
is also used and usually used concurrently with Streptomycin.
The recommended loading dose is 15 mg./kilogram orally, all
the way up to one gram for a total dose. This is then followed
by 40-50 mg./kilogram in 6 divided doses every 4 hours on
the first day. After that, you can go to 30 mg./kilogram orally
in 4 divided doses every 6 hours for 10-14 days.
For further information, please see Wilderness
Medicine by Dr. Auerbach.
