Dubbi de Ubbi

Bacteriology

Epidemiology

The plague is regarded by WHO as an Re-emergent disease.

From 1984 to 1992: 11030 cases of human plague successor in title 1201 deaths were notified throughout the world (either of: 1000 with: 2000 cases and from 100 to 200 deaths per annum), 95% of the cases being African. A Malagasy hearth is responsible for 40% of the world cases. It was primarily about bubonic plague (between 80 and 95% of the cases) with a mortality ranging between 10 and 20%.

Natural basin of the germ

The wild tank interests the small rodents and their environment. epizooty S appear during the variations of population and of the modification of the ecological environment of these rodents. The man contaminates himself directly with their contact, or by the passage of epizooty to the domestic rodents. At the time of epidemic, the domestic rat becomes the tank of the germ.

In Europe, the Rat S are the primary source of dissemination of the plague, in the United States they are the squirrel S Rock squirrels and California ground squirrels . The pets, Dog S and Cat S, can be sources of infection when they are contaminated by the chips of rodents. The chips remain infectious during months.

Hearths of plague in the world

According to WHO, the Africa is the continent more touched (high plateaus of the center of the island of Madagascar, the Mozambique, the Tanzania, the Democratic republic of Congo) followed Asia (India). With them two, they gather nearly 99% of the cases brought back in the World in 1997.

South America and the west of the United States indexed some cases in 1997. The plague is currently non-existent in Europe.

Transmission

The man is contaminated by the puncture of infected chip, in particular Xenopsylla cheopis (the chip of the rat), by the bite of an infected rodent, even by eating sick animals.

The most widespread model of transmission passes by the chips which transmit the bacterium of the plague to the man at the time of a blood meal.

At the time of the epidemic, the transmission can be made by respiratory tract interhumaine if one of the patients is reached of an open respiratory lesion.

Physiopathology

The germ contained in blood is introduced by a hematophagous chip, it multiplies and blocks the digestion of the ectoparasite. This last is famished, and must be again nourished. The full stomach, it vomits at the time of the puncture to have a new meal.

After bite of the infected chip, the germ multiplies at the point of inoculation leaving a vesicular pustule then gains the lymphatic system and colonizes the satellite ganglia of the point of inoculation (the bubo). One or more adénites located and suppurées appears. The evolution of the dissemination by hematogen way makes it possible the germ to reach the whole of the bodies and the lungs where it will develop a secondary pulmonary localization. The bacillus multiplies in the macrophages and releases a toxin when it is destroyed.

Diagnosis

Historical description

The plague is described since the Antiquité. With the 6th century, Gregoire de Tours written:

Later to the 16th century, Nicolas de Nancel gives following description of it:

Clinical elements

The plague is expressed in three different clinical forms sometimes being able to follow one another in time:

Bubonic plague

Form most frequent in natural environment, the Bubonic plague makes following the puncture of the chip of a rat or an infected rodent. The plague is declared initially in the rodents which die in large scales. The chips losing their host seek other sources of blood, and contaminate the man and the pets by puncture. After an incubation of less than one week, a septic state with high Fièvre without dissociation of pulse appears brutally, Frisson S, Vertige S, feeling of faintness. The clinical examination detects the bubo at the second day. The bubo is a Adénopathie (or increased ganglion of volume) or ganglionic, satellite package of the territory of drainage of the puncture of the Ectoparasite, inflammatory, suppuré and very œdémateux. The generally touched ganglionic surfaces are the surface inguinale or crurale fold of the groin), more rarely axillaire even cervical. Signs of Dehydration and neurological failure will accelerate the evolution of the disease towards a death in less than seven days in the absence of effective cure. One estimates between 20 and 40% the number of patients who will cure spontaneously after a rather long time of convalescence.

Septicemic plague

This form constitutes 10 to 20% of the plagues and holy Sebastien (see Saints antipesteux );

to organize processions of Whipping, to burn the heretics, the Jews and the leprous ones shown to propagate the disease (see Black Death: Consequences);
the Thériaque, made up of multiple plants, was used, its content of opium was to slightly decrease the diarrhea and the pains;
the Bézoard S, animal secretions (blood of viper and dribbles of clamping plate), were largely used with the success which one guesses;
the purging and the bleeding, by worsening the state of shock and the diarrhea, perhaps made it possible to shorten the sufferings of the patients;
the treatment says “electuary of the three adverbs”: “ cito, skirts, delays ”, (leave) quickly, (goes) far, (return) late (treatment not always easy to implement, and likely to propagate even more the disease);

As from the 16th century, measurements of insulation appear, with disinfection and fumigation of the houses, insulation of the patients, disinfection of the mail and the currencies, creation of hospital out the walls, incineration of deaths. The setting in systematic quarantine the suspect ships proves to be effective to avoid new epidemics, each relaxation of the attention recalling without delaying the possible consequences (see Peste of Marseilles (1720)).

The mask with the duck nozzle (see photo) was imagined by De Lorme, doctor of Louis XIII, one placed there aromatic plants at the disinfecting properties, in particular Girofle and Romarin. One will also quote the vinegar of the four robbers (white vinegar, wormwood, juniper, marjoram, sage, clove, rosemary and camphor) impregnating a sponge which one carried in front of the mouth, and which was supposed to protect from the contagion.

The tradition announces that three professions are saved: the chevrier S and Stableman S (because the odor of the goats and the horses would push back the chips of the rat) and oil carriers because the oil which them oint would push back it also the chips.

Current treatment

The treatment by Antibiotique S remains the key about it.

Yersinia pestis is naturally resistant to the beta-lactam antibiotic S but remains sensitive to the Aminoside S (Streptomycine, Gentamycine and with the Kanamycine (for the new born ones)), with the cyclines (Tétracycline), with the Chloramphenicol (in the cases of meningitis), with the Quinolone S, triméthoprime-sulfaméthoxale (TMP-SMX), the Rifampicine.

The route of perhaps oral or parenteral administration and the antibiothérapie must be prescribed at the early stage (8 with 24:00 after the beginning of the pulmonary plague) to obtain a maximum of effectiveness.

It was described rare stocks resistant to several of these antibiotics. This situation remains, for the moment, exceptional.

It can be necessary to incise the bubo and to make a drainage.

Protection measures of public health

The plague is a disease with epidemic potential which justifies an early diagnosis and requires a declaration with the national and international health authorities.

In France, the plague belongs to the Infectious illness to obligatory declaration near DDASS. (Disease n°9)

According to the Plane Biotox of the Head office of French Health, the protection measures to be taken are:

to carry an early diagnosis;
to very quickly declare with the health authorities the suspicion of a case of plague;
of launching an epidemiological investigation to identify the exposed source and people;
to hospitalize any symptomatic patient in a medicalized structure particularly those which are reached respiratory forms.
to limit displacements to avoid the extension of the epidemic;
to manage a Antibioprophylaxie by cyclines, rifampicine or streptomycine on the subjects in contact.

The desinsectisation and the fight against the tanks of animals are determining in the prevention of an epidemic.

Vaccination

There exists a Vaccin but it is only used to protect the strongly exposed people with the disease, such as for example, the military personnel in certain operational circumstances, or of people who work with animals in endemic areas of the plague. So that it is very effective, it must be injected with multiple amounts and of the injections of recall must be carried out regularly (weak duration of action) what involves important side effects. It is not available to the public.

The old vaccine is not manufactured any more and was effective only against the bubonic plague. New tests of vaccine are in hand since 2005 in Canada.

History of the plague and the epidemics

The plague is evoked in the Old will like a plague sent by God to the Hebrews. The king David is punished by God and must make the choice between undergoing the war, the famine or the plague; he chooses the plague (Book II Samuel 24).

The Greek would have also undergone the disease. Thucydide evokes an infectious epidemic at the time of the conflict between Sparte and Athens towards 430 av. J-C which one generally considers to be the plague.

The Roman S allotted the plague to the revenge on Apollon during plundering of the one of its temples. Claude Galien would have carried out the first descriptions of the disease at the time of the Peste antonine which prevails with Rome in the year 166.

The frequent epidemic S of plague during the Antiquité disappeared from the Occident at the beginning of the Moyen-âge, after the plague of Cyprien (towards 250) and the epidemics called Peste of Justinien (second half of the 6th century).

The plague as a bacteriological weapon

The plague was used as arms by the Armée imperial Japanese woman at the time of the invasion with China, in particular in the area of Changde. These weapons were used following tests carried out by bacteriological research units as the Unité 731 which practiced experiments on the human ones.

Later, the Americans, who had pardoned the war criminals of the team of Shiro Ishii, and the Russians, who had condemned for war crimes twelve Japanese at the time of the lawsuit of Khabarovsk, worked on aerosols of Yersinia Pestis

The macabre dances were representations of the episodes of plague in particular that of the church of Lübeck (1460) now disappeared.

The topic of the plague will inspire by many artists such

David ( Saint Roch interceding near the Virgin for the patients of the plague , (1780)),
Raphaël,
Antoine-Jean Large ( Bonaparte visiting the pestiferous ones of Jaffa ),
Jules-Élie Delaunay,
Jean-François de Troy…

The plague in the current language

Formerly three words summarized the precautions to be taken against the plague: , implying that as of the appearance of the first signs of the disease in a place, it was necessary to leave quickly, go far and to remain there a long time.

The word plague became with the wire of time a qualifier for all infectious epidemics especially in antiquity and with the Middle Ages. It entered the popular speech to nominate a thing or a person pernicious, malicious, bad or mischievous then in expressions such to flee something like the plague showing the will to avoid somebody or a thing in an absolute way.

See too

List of the Holy epidemics of plague
anti-pesteux
the Cattle plague, the avian Plague, the porcine Peste
the Nazisme was called the brown Peste. Albert Camus takes again this analogy in its work the plague .

External bonds

College library of Medicine - the plague

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