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Black Plague

Is the Black Plague Back? Do we have cause to worry?

Nurses Disasters Article News   posted
Nurse Beth Nurse Beth, MSN (Columnist)

Nurse Beth specializes in Med Surg, Tele, ICU, Ortho.

The Black Plague has been in the news recently, with a couple in China having contracted the highly deadly disease.

Black Plague
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Black Plague

Recently it’s been in the news that two people from the Chinese province of Inner Mongolia have contracted the plague and are being treated in Bejing.

The plague has been with us since biblical times. The Black Plague is known as being one of the most devastating pandemics in all of history. The Black Plague killed millions of men, women, and children in Europe from 1347 to 1351 and is estimated to have wiped out 30-60% of Europe’s population. The Black Plague originated in Central Asia where rodents carried it to Crimea and beyond. It’s believed black rats carried the fleas that carried the bacteria. Black rats, also called ship rats and roof rats, inhabited almost all merchant ships.

The plague is caused by an organism called yesinia pestis. Back when the plague was rampant it turned people’s fingers, nose, and toes black, which is why it came to be known as the Black Death and the Black Plague. It’s a swift but painful, horrifying death- victims vomit, bleed, and develop gangrene of the extremities.

Types

Humans are extremely susceptible to the plague. There are 3 types: the pneumonic plague, the bubonic plague and the septicemic plague with pneumonic plague being the deadliest form.

Bubonic plague affects the lymph glands while septicemic plague affects the bloodstream. Symptoms appear 2-5 days after exposure. The bacteria quickly multiply in the lymph nodes closest to the flea bite and spreads to other parts of the body. Tender, painful lymph nodes, called buboes, are a hallmark of bubonic plague. Bubonic plague can lead to septicemic plague once the bacteria crosses to the bloodstream.

In septicemic plague, patients present with fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Septicemic plague can occur as the first symptom of plague, or may develop from untreated bubonic plague. The time between being infected and developing symptoms is typically 2 to 8 days.

While all 3 are deadly, the pneumonic plague affects the lungs and can be contracted through infectious droplets coughing or sneezing. Anyone who inhales the droplets can become infected. The incubation period can be as short as 1 day for pneumonic plague. Victims are lucky to live more than 48 hours. Pneumonic plague can often be mistaken for the flu.

People with pneumonic plague must be isolated. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

Transmission

Plague is vecxtor-borne, carried by fleas that cling to the fur of rats and other animals, and infecting humans through flea bites. Plague cannot pass from human to human, with the exception of the deadly pneumonic plague.

Outbreaks

While most think the plague is extinct, it has not been eliminated and is very much alive today. The bacteria lives on rodents in most all continents, but outbreaks typically occur in poverty-stricken rural areas. It is found in Africa, Asia and South America. The WHO has classified the plague as a re-emerging infectious disease.

There was an outbreak of bubonic plague in New Orleans back in 1914. Rat containment prevented it from becoming a pandemic. In Honolulu in the early 1900s, firefighters burned the houses on either side of a plague victim's home in an attempt to stop the spread of the disease.

In recent times in the United States, plague is rare, but not non-existent. Approximately 10 cases are still reported each year. It has been known to occur in the western states of California, Arizona, Colorado, and New Mexico.

Treatment

People with the plague need to be treated right away. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases. Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin as well as supportive measures are used to treat the plague.

Outlook

While antibiotics are life-saving, some fear that if the bacteria develop resistance, another pandemic could occur. How likely are the chances of an epidemic or pandemic in the United States? Not very.

But because it is so deadly, awareness is important. Early detection is key.

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.

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FullGlass, BSN, MSN, NP

Specializes in Adult and Geriatric Primary Care.

I believe the chances of plague-type diseases is increasing in the US. There has been a typhus outbreak in Los Angeles. Cities with large homeless populations generate a lot of filth, such as human defecation and garbage, on the streets. This draws rats. In cities like Palo Alto, CA, where people live in vehicles, they are dumping raw sewage on the streets.

Hoosier_RN, MSN

Specializes in dialysis.

Thanks for educating us on this. I do believe Fullglass is right, the situations definitely exists for this, as well as many other deadly diseases, to come to roost anywhere in the US, especially where there are large homeless populations

nursej22, MSN, RN

Specializes in med/surg,CV.

Not only typhus but Hepatitis A is a threat to the homeless. Finding affordable housing is no longer a humanitarian crisis, but also a public health crisis.
On a side note, did you know prairie dogs can spread Yersinia pestis?

Hoosier_RN, MSN

Specializes in dialysis.

7 hours ago, nursej22 said:

On a side note, did you know prairie dogs can spread Yersinia pestis?

No, wow!

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, Elder Care, L&D.

I just read this article about the black plague and it proposes that the plague was actually spread by human body lice which is why in spread like wild fire in crowed Winter conditions. Still the plague at the time was seen as the Devils work and therefor could not have been spread by a human vector.

https://www.Google.com/search?q=Black+plague+not+caused+by+rats

Asystole RN, BSN, RN

Specializes in Vascular Access, Infusion Therapy.

On 11/16/2019 at 9:40 AM, hppygr8ful said:

I just read this article about the black plague and it proposes that the plague was actually spread by human body lice which is why in spread like wild fire in crowed Winter conditions. Still the plague at the time was seen as the Devils work and therefor could not have been spread by a human vector.

https://www.Google.com/search?q=Black+plague+not+caused+by+rats

I think the hypothesis is more accurately described as human parasites having been an additional vector in early plague epidemics.

Hmmm, the plague is back eh? It's like the weed in the back yard you kill and it comes back next year. I remember there was a debate on destroying the last samples of smallpox in labs. Good thing we didn't.

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine.

Plague was there and is there. All US Southwestern region is endemic zone, prairie dogs being a vector. Also areas in Cali and Oregon. About 7 to 15 cases /year, mostly in rural areas

https://www.cdc.gov/plague/maps/index.html

I wish it could be different. Wanna to play with prairie dogs one day as I do it with squirrels (I have a couple in neighborhood which come if called and can be hand -fed 🙂 )

Other endemic zones are Northern China, Mongolia, Kazachstan, Kyrgizstan, pretty much all Central Azia - plus India. Total 1000 to 3000 cases/year by WHO.

The birthplace of Great Plague is still disputed, likely Northern China. It spread by the Gread Silk Road through Central Asia to free italian cities of Genoa and Venice and took the full way from there. Apparently, it was a particular mutation which increased virulence. The genome was decoded in 2011:

https://www.genome.gov/27546229/dissecting-the-cause-of-the-black-death

The million-dollar question which is not yet solved is where exactly and (hopefully) why the Y. pestis mutated, as, apparently, the Great Silk Road ran business as usual for a while even after start of epidemy.

Also, the plague came upon a population which was at that time passing through the Great Crisis of Late Medieval Europe. It had way more features than lack of common hygiene. There was almost 100% malnutrition (including the uppest of the upper class), crowded conditions and tons of other stuff going on. A healthy man at his life's prime could die from mundane acute enterocolitis (and from the treatment which was used with all good intentions) - that what happened with Henry the V of England.

Anyone who is interested, please send me private message and I will be happy to provide list of basic literature to get familiar with the subject.

Bubonic form IS NOT contagious between humans - that's why Napoleon was parading himself so "fearlessly" between his soldiers dying from it in Jaffa:

https://www.louvre.fr/en/oeuvre-notices/napoleon-bonaparte-visiting-plague-stricken-jaffa

Also, bubonic plague is treated with Cipro or doxycycline in common therapeutic doses for 10 days, just like some community acquired pneumonia. Pulmonic plague, on the other hand, is very contagious airborne and remains a killer even with all modern medicine on board.

The last significant outbreak in modern history was in Dakar in 1960th. It was stopped by strict quarantine (the word, BTW, comes from one mid-medieval Italian dialect word "quaranta", means "forty" - the coming ships had to stay away from harbor for 40 days to make sure they do not carry sick on board. Those who got sick for any reason were just quietly thrown in the sea - some ships had a problem with getting into harbor after all that, as they had not enough crew and nobody from the land would go there for any amount of gold) and massive "tetracyclinyning" of pretty much entire population. Cipro was not on board yet; it is a medicine of first choice now both fof treatment and prevention. Total was about 2500 sick and less than 5% mortality.

The only one guy who came close to stopping Black Plague was Guy de Chauliak, a French physician. He thought that the problem was "bad", cold and wet air, so he ordered a few high-ranked guys, including Pope of Rome who could afford his services, to get air around them hot and dry at all times - that's it, living in a room heated to high temp by huge bonfires and leaving it only when there was absolutely no other choice and for the shortest time possible. The very high temp made fleas leaving human bodies, so the high-ranked guys remained healthy.

Reading through this thread and look at us now. It's not the plague, it's just as bad though. *sigh*

herring_RN, ASN, BSN

Specializes in Critical care, tele, Medical-Surgical.

Many types of animals, such as rock squirrels, wood rats, ground squirrels, prairie dogs, chipmunks, mice, voles, and rabbits can be affected by plague. Wild carnivores can become infected by eating other infected animals.

https://www.CDC.gov/plague/transmission/index.html

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