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Bubonic plague is the best known manifestation of the bacterial disease plague, caused by the Gram-negative bacterium Yersinia pestis (formerly known as Pasteurella pestis). It belongs to the family Enterobacteriaceae. The term "bubonic plague" was often used synonymously for plague, but it does in fact refer specifically to an infection that enters through the skin and travels through the lymphatics, as is often seen in flea-borne infections. Bubonic plague kills about half of infected patients in 3–7 days without treatment, and may be the Black Death that swept through Europe in the 1340s, killing tens of millions.

Pathology and transmission

The bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, Xenopsylla cheopis (the rat flea). The fleas are often found on rodents, such as rats and mice, and seek out other prey when their rodent hosts die. The bacteria form aggregates in the gut of infected fleas and this results in the flea regurgitating ingested blood, which is now infected, into the bite site of a rodent or human host. Once established, bacteria rapidly spread to the lymph nodes and multiply. Yersinia pestis bacilli can resist phagocytosis and even reproduce inside phagocytes and kill them. As the disease progresses, the lymph nodes can haemorrhage and become swollen and necrotic. Bubonic plague can progress to lethal septicemic plague in some cases. The plague is also known to spread to the lungs and become the disease known as the pneumonic plague. This form of the disease is highly infectious as the bacteria can be transmitted in droplets emitted when coughing or sneezing.

Symptoms

The most famous symptom of bubonic plague is painful, swollen lymph glands, called buboes. These are commonly found in the armpits, groin or neck. The bubonic plague was the first step of the ongoing plague. Two other forms of the plague, pneumonic and septicemic, resulted after a patient with the bubonic plague developed pneumonia or blood poisoning. The Pneumonic plague was the most infectious, as, unlike the bubonic or septicemic, it induced coughing, which allowed person-to-person spread.

Other symptoms include spots on the skin that are red at first and then turn black, heavy breathing, continuous blood vomiting, aching limbs, coughing, and terrible pain. The pain is usually caused by the actual decaying, or decomposing, of the skin while the person is still alive.

History

The deadly disease has claimed nearly 200 million lives (although there is some debate as to whether all of the plagues attributed to it are in fact the same disease). The first recorded epidemic ravaged the Byzantine Empire during the sixth century, and was named the Plague of Justinian after emperor Justinian I, who was infected but survived.

The most infamous and devastating instance of the plague was the Black Death, which killed a quarter to half of the population of Europe. The Black Death is thought to have originated in the Gobi Desert. Carried by the fleas on rats, it spread along trade routes and reached the Crimea in 1346. In 1347 it spread to Constantinoplemarker and then Alexandriamarker, killing thousands every day, and soon arrived in Western Europe. It is thought that the name Black Death comes from the fact that the tissue turns a distinctive black color during necrosis, or from the general gloominess surrounding the plague.

The next few centuries were marked by several local outbreaks of lesser severity. The Great Plague of London, 1665–1666, and the Great Plague of Vienna, 1679, were the last major outbreaks of the bubonic plague in Europe.

The plague resurfaced in the mid-19th century; like the Black Death, the Third Pandemic began in Central Asia. The disease killed millions in China and India and then spread worldwide. The outbreak continued into the early 20th century. In 1897, Punemarker in British Indiamarker, was severely affected by the outbreak. The government responded to the plague with a Committee system that used the military to perpetrate repression and tyranny as it tackled the pandemic. Nationalists publicly berated the government. On 22 June 1897, two young brahmins, the Chapekar brothers, shot and killed two British officers, the Committee chairman and his military escort. This act has been considered a landmark event in Indiamarker's struggle for freedom as well as the worst violence against political authority seen in the world during the third plague pandemic.



Plague was used during the Second Sino-Japanese War as a bacteriological weapon by the Imperial Japanese Army. These weapons were provided by Shirō Ishii's units and used in experiments on humans before being used on the field. For example, in 1940, the Imperial Japanese Army Air Service bombed Ningbomarker with fleas carrying the bubonic plague. During the Khabarovsk War Crime Trials the accused, such as Major General Kiyashi Kawashima, testified that, in 1941, some 40 members of Unit 731 air-dropped plague-contaminated fleas on Changdemarker. These operations caused epidemic plague outbreaks.

Treatment

In modern times, several classes of antibiotics are effective in treating bubonic plague. These include the aminoglycosides streptomycin and gentamicin, the tetracyclines tetracycline and doxycycline and the fluoroquinolone ciprofloxacin. Patients with plague in the modern era usually recover completely with prompt diagnosis and treatment.

See also



Notes

  1. Japan triggered bubonic plague outbreak, doctor claims, [1], http://www.scaruffi.com/politics/wwii.html, A time-line of World War II, Scaruffi Piero. Prince Tsuneyoshi Takeda and Prince Mikasa received a special screening by Shirō Ishii of a film showing imperial planes loading germ bombs for bubonic dissemination over Ningbo in 1940. (Daniel Barenblatt, A Plague upon Humanity, 2004, p.32.)
  2. Daniel Barenblatt, A Plague upon Humanity, 2004, pages 220–221.


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