| Septicemic plague | |
|---|---|
| Other names | Septicaemic plague |
 | |
| Septicemic plague resulting in necrosis | |
| Specialty | Infectious diseases  |
| Symptoms | DIC (disseminated intravascular coagulation) which causes : tissue death due to lack of circulation/perfusion to that tissue, bleeding into the skin and other organs, which can cause red and/or black patchy rash and hemoptysis/hermatemesis |
| Complications | Gangrene |
| Usual onset | 1 to 7 days after exposure |
| Causes | Yersinia pestis |
| Diagnostic method | Typically by finding the bacterium in fluid form from blood or sputum |
| Treatment | With antibiotics and vaccination |
| Prognosis | Invariably fatal when left untreated |
| Frequency | 10% of all Plague cases (CDC MMWR 2015)[1] |
Septicemic plague is one of the three forms ofplague, and is caused byYersinia pestis, agram-negative species ofbacterium.Septicemic plague is asystemic disease involving infection of the blood and is most commonly spread by bites from infected fleas. Septicemic plague can causedisseminated intravascular coagulation and is always fatal when untreated. The other varieties of the plague arebubonic plague andpneumonic plague.[2]
These symptoms are common to many human illnesses and are not considered, in and of themselves, to signify infection with any form of plague.[citation needed]
Septicemic plague may beasymptomatic and may cause death absent of any symptoms.[citation needed]
HumanYersinia infections most commonly result from the bite of an infected flea or occasionally an infected mammal.
Rats specifically were a mammal that played a huge part in the spread of the disease. When rats that carried the plague died of the disease, then thefleas that were using those rodents as a food source must quickly seek a different blood stream, making things very problematic for any human nearby.
After a flea consumes the blood of an infected rat, they are unable to get blood to their stomachs as masses form due to theYersinia bacteria that is now in the flea. These masses don't allow for blood to be processed properly, leaving the flea feeling constant hunger, and this results in more bites on humans.[4] The exposure to a flea bite from an infected flea may cause bubonic plague in humans that could develop into the septicemic plague.
Cats and dogs were also susceptible to bites from infected fleas. These cats and dogs could then expose humans to the plague when the animal brings those infected fleas around people.[5]
However, like most bacterialsystemic diseases, the disease may also be transmitted through an opening in the skin. It can also be transmitted by inhaling infectious droplets of moisture from sneezes or coughs, if the bacteria spread to the lungs andpneumonic plague develops. In both cases septicemic plague need not be the result, and in particular, not the initial result, but it occasionally happens that bubonic plague for example leads to infection of the blood, and septicemic plague results. If the bacteria happen to enter the bloodstream rather than the lymph or lungs, they multiply in the blood, causingbacteremia and severesepsis. In septicemic plague, bacterialendotoxins cause disseminated intravascular coagulation (DIC), where tiny blood clots form throughout the body, commonly resulting in localisedischemicnecrosis, tissue death from lack of circulation andperfusion.[citation needed]
DIC results in depletion of the body'sclotting resources, so that it can no longer control bleeding. Consequently, the unclotted blood bleeds into the skin and other organs, leading to a red or black patchy rash and tohematemesis (vomiting blood) orhemoptysis (coughing up blood). The rash may cause bumps on the skin that look somewhat like insect bites, usually red, sometimes white in the centre.[citation needed]
Septicemic plague is caused by horizontal and direct transmission.[6] Horizontal transmission is the transmitting of a disease from one individual to another regardless of blood relation. Direct transmission occurs from close physical contact with individuals, through common air usage, or from direct bite from a flea or an infected rodent. Most common rodents may carry the bacteria and so mayLeporidae such as rabbits.
The bacteria are cosmopolitan, mainly in rodents on all continents except Australia and Antarctica. The greatest frequency of human plague infections occurs in Africa. The bacteria most commonly appear in rural areas and wherever there is poor sanitation, overcrowding, and high rodent populations in urban areas. Outdoor activities such as hiking, camping, or hunting where plague-infected animals may be found, increase the risk of contracting septicemic plague, and so do certain occupations such as veterinary or other animal-related work.[2]
A doctor or veterinarian will perform a physical exam which includes asking about the medical history and possible sources of exposure.[7] The following possible test could include:
The following steps and precautions should be used to avoid infection of the septicemic plague:[2][8]
Starting antibiotics early is the first step in treating septicemic plague in humans. One of the following antibiotics may be used:[citation needed]
Lymph nodes may require draining and the patient will need close monitoring.[2]
In animals, antibiotics such as tetracycline or doxycycline can be used. Intravenous drip may be used to assist in dehydration scenarios. Flea treatment can also be used. In some cases, euthanasia may be the best option for treatment and to prevent further spreading.[8]
Untreated septicemic plague is almost always fatal. Early treatment with antibiotics reduces the mortality rate to between 4 and 15 per cent. Death is almost inevitable if treatment is delayed more than about 24 hours, and some people may even die on the same day theypresent with the disease.[citation needed]
In 2015, Taylor Gaes, a 16-year-old in Larimer County in northern Colorado, contracted septicemic plague and subsequently died after being bitten by a flea that had bitten a rodent on his family's rural property.[9] Only three people in Colorado had contracted the bacteria in the previous thirty years.[10]
The septicemic plague was the least common of the three plague varieties that occurred during theBlack Death from 1348 to 1350[11] (the other two beingbubonic plague andpneumonic plague). Like the others, septicemic plague spread fromEast Asia through trade routes on theBlack Sea and down to theMediterranean Sea.[citation needed]
Majorport cities and trade centres such asVenice andFlorence were hit the hardest. The massive loss of the working population in Europe following the Black Death, resulting in the increased economic bargaining power of theserf labour force, was a major precipitating factor for thePeasants' Revolt of 1381.[citation needed]
Septicemic plague is azoonosis,[12] a disease that generally is acquired by humans from animals, such as rodents and carnivores. Goats, sheep and camels also may carry the bacteria. Cats rarely develop clinical signs but can be infected and exhibit symptoms such as vomiting or diarrhea.[13] Areas west of the Great Plains of North America are one region where plague-infected animals commonly occur. Plague-infested animals are found in many other countries as well, especially in developing countries where health controls are not effective.[citation needed]
Animals that commonly carry plague bacteria are large rodents andLeporidae, butcarnivores sometimes also become infected by their prey. Prey animals are not immune to the disease, and outbreaks of various strains of plague, such assylvatic plague, have on occasion devastated populations ofblack-tailed prairie dogs andblack-footed ferrets.[14]
Plague has been active in black-tailed prairie dog populations since the 1960s. In the United States outbreaks only occur in the western States and they are devastating, with mortality rates near 100% because the animals have no immunity to the plague. Survivors are the ones that happened not to become infected and colonies that recover from a plague outbreak remain at risk.[15]
Because black-footed ferrets prey on black-tailed prairie dogs, wild ferret populations also fall victim to sylvatic plague. An outbreak can kill nearly 100% of ferrets in a population, and surviving ferrets commonly face starvation because prairie dogs are their main prey. Spray-and-vaccinate campaigns have aimed at preventing the spread of the plague among these animals.[16]
Similar septicemic problems occur in many countries across the world, especially in developing countries where spending on health systems is very low and health controls are not effective.[citation needed]
