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Plague: Yersinia pestis 

Plague: Yersinia pestis

Chapter:
Plague: Yersinia pestis
Author(s):

Michael B. Prentice

DOI:
10.1093/med/9780199204854.003.070616_update_001

Update:

Areas of uncertainty or controversy—advances in ancient DNA sequencing have firmly established Yersinia pestis as the cause of the Black Death.

Further reading—references updated, ancient DNA references added.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 30 March 2017

Bubonic plague is a flea-borne zoonosis caused by the Gram-negative bacterium Yersinia pestis, which mainly affects small burrowing mammals including domestic rats. Human disease occurs in endemic countries—currently mainly in Africa (including Madagascar)—following bites from fleas recently hosted by a bacteraemic animal. Historical use of Y. pestis as a biological warfare agent has raised fears of its future use in bioterrorism.

Clinical features—the commonest presentation is acute painful lymphadenitis (80–95% of suspected cases), with sudden onset of fever, chills, weakness, headache and development of an intensely painful swollen lymph node (bubo). Spread to the lungs occurs in less than 10% of cases, resulting in pneumonia which can result in onward respiratory transmission by droplet infection. Overall mortality without treatment is 50 to 90%.

Diagnosis and treatment—diagnosis is usually by culture from appropriate specimens (blood culture, bubo aspirate, sputum, cerebrospinal fluid), but rapid confirmation can be provided by detection of Yersinia pestis F1 antigen by immunofluorescence in clinical material. Aside from supportive care, early antimicrobial therapy (usually with streptomycin, gentamicin, or doxycycline) greatly improves survival.

Prevention—is by reducing the likelihood of people being bitten by infected fleas, or being exposed to infected droplets from humans or animals with plague pneumonia. Postexposure chemoprophylaxis may be advised for those who have been in unprotected close contact with a person with pneumonic plague. There is no current vaccine.

Acknowledgement: The author gratefully acknowledges the substantial contribution to this chapter made by Dr Tom Butler based on previous editions.

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