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'{{About|the disease in general|information about the medieval European plague|Black Death}} {{Refimprove|date=April 2011}} {{Infobox disease | Name = Bubonic plague | Image = Plague_-buboes.jpg | Caption = a person infected with bubonic plague | ICD10 = {{ICD10|A|20|0|a|00}} | ICD9 = {{ICD9|020.0}} | DiseasesDB = 14226 | MedlinePlus = | eMedici neSubj = | eMedicineTopic = | MeshName = | MeshNumber = D010930 }} '''Bubonic plague''' is a [[zoonotic disease]], circulating mainly among small rodents and their [[flea]]s,<ref>{{cite web |url=http://allcountries.org/health/plague.html |title=Plague, Overview |work=Health Topics A to Z |accessdate=2010-10-23}}</ref> and is one of three types of infections caused by ''[[Yersinia pestis]]'' (formerly known as ''Pasteurella pestis''), which belongs to the family [[Enterobacteriaceae]]. Without treatment, the bubonic plague kills about two out of three infected humans within 4 days. The term ''bubonic plague'' is derived from the Greek word [[bubo]], meaning "swollen gland". Swollen [[lymph node]]s (buboes) especially occur in the armpit and groin in persons suffering from bubonic plague. ''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 — along with the [[septicemic plague]] and the [[pneumonic plague]], which are the two other manifestations of ''[[Yersinia pestis|Y. pestis]]'' — is generally believed to be the cause of the [[Black Death]] that [[Black Death migration|swept through Europe]] in the 14th century and killed an estimated 75 million people, or 30-60% of the European population.<ref>{{cite journal | doi = 10.1371/journal.ppat.1001134 | title = Distinct Clones of Yersinia pestis Caused the Black Death | journal = PLoS Pathogens | editor1-first = Nora J. | volume = 6 | issue = 10 | pages = e1001134 | date = 2010-09 | editor1-last = Besansky | first = Stephanie | last = Haensch | pmid = 20949072 | coauthors = Raffaella Bianucci, Michel Signoli, Minoarisoa Rajerison, Michael Schultz, Sacha Kacki,, Marco Vermunt, Darlene A. Weston, Derek Hurst, Mark Achtman, Elisabeth Carniel, Barbara Bramanti | pmc = 2951374| id = | url = http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1001134 | accessdate = 2010-11-16 | quote = We confirm that Y. pestis caused the Black Death and later epidemics on the entire European continent over the course of four centuries. Furthermore, on the basis of 17 single nucleotide polymorphisms plus the absence of a deletion in glpD gene, our aDNA results identified two previously unknown but related clades of Y. pestis associated with distinct medieval mass graves. These findings suggest that plague was imported to Europe on two or more occasions, each following a distinct route. These two clades are ancestral to modern isolates of Y. pestis biovars Orientalis and Medievalis. Our results clarify the etiology of the Black Death and provide a paradigm for a detailed historical reconstruction of the infection routes followed by this disease.}}</ref> Because the plague killed so many of the working population, wages rose and some historians have seen this as a turning point in European economic development.<ref>{{cite book |author=Bowsky, William |title=The Black Death: A Turning Point in History? |format= |publisher=Holt, Rinehart and Winston |year=1971 |isbn=9780030850004}}</ref><ref>{{cite book |author=Bridbury, A.R. |title=Economic Growth: England in the Later Middle Ages |format= |publisher=Greenwood Press |year=1983 |isbn=9780313240669}}</ref> ==Signs and 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. Due to its bite-based form of infection, the bubonic plague is often the first step of a progressive series of illnesses. Bubonic plague symptoms appear suddenly, usually 2–5 days after exposure to the bacteria. Symptoms include: *[[Chills]] *General ill feeling ([[malaise]]) *High fever (39 °Celsius; 102 °Fahrenheit) *Muscle Cramps<ref>{{cite web|title=Plague|url=http://www.itriagehealth.com/disease/plague-(bacteria-yersinia-infection)|publisher=Healthagen, LLC|accessdate=4/1/11}}</ref> *[[Seizures]] *Smooth, painful lymph gland swelling called a bubo, commonly found in the groin, but may occur in the armpits or neck, most often at the site of the initial infection (bite or scratch) *Pain may occur in the area before the swelling appears *Skin color changes to a pink hue in some extreme cases *Bleeding out of the [[cochlea]] will begin after 12 hours of infection. Other symptoms include heavy breathing, continuous blood vomiting, urination of blood{{Citation needed|date=September 2010}}, aching limbs, coughing, and extreme pain. The pain is usually caused by the decay or decomposure of the skin while the person is still alive. Additional symptoms include extreme fatigue, gastrointestinal problems, lenticulae (black dots scattered throughout the body), delirium and [[coma]]. Two other types of ''[[Yersinia pestis|Y. pestis]]'' plague are pneumonic and septicemic. However, [[pneumonic plague]], unlike the bubonic or septicemic, induces coughing and is very infectious, allowing to it be spread person-to-person. ==Pathophysiology== 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 node]]s and multiply. ''[[Yersinia pestis|Y. 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 [[Necrosis|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 communicable as the bacteria can be transmitted in droplets emitted when coughing or sneezing, as well as physical contact with victims of the plague or flea-bearing rodents that carry the plague. ==Treatment== Several classes of [[antibiotics]] are effective in treating bubonic plague. These include [[aminoglycoside]]s such as [[streptomycin]] and [[gentamicin]], [[tetracyclines]] (especially [[doxycycline]]), and the [[fluoroquinolone]] [[ciprofloxacin]]. Mortality associated with treated cases of bubonic plague is about 1-15%, compared to a mortality rate of 50-90% in untreated cases.<ref>{{Cite web |title = Plague |url = http://emedicine.medscape.com/article/829233-overview |accessdate = 2010-02-25 }} </ref> People potentially infected with the plague need immediate treatment and should be given antibiotics within 24 hours of the first symptoms to prevent death. Other treatments include oxygen, intravenous fluids, and respiratory support. People who have had contact with anyone infected by pneumonic plague are given prophylactic antibiotics.<ref>{{cite web|title=Plague|url=http://www.itriagehealth.com/disease/plague-(bacteria-yersinia-infection)|publisher=Healthagen, LLC|accessdate=4/4/11}}</ref> ==Laboratory testing== Laboratory testing is required, in order to [[Medical diagnosis|diagnose]] and confirm plague. Ideally, confirmation is through the identification of ''Y. pestis'' [[Microbiological culture|culture]] from a patient sample. Confirmation of infection can be done by examining [[Blood serum|serum]] taken during the early and late stages of [[infection]]. To quickly screen for the ''Y. pestis'' [[antigen]] in patients, rapid [[dipstick]] tests have been developed for field use.<ref>{{cite web |url=http://allcountries.org/health/plague.html |title=Plague, Laboratory testing |work=Health Topics A to Z |accessdate=2010-10-23}}</ref> ==History== Bubonic plague is believed{{vague|date=April 2011}} to have claimed nearly 200 million lives in total, although there is some debate as to whether all of the plagues attributed to it are in fact the same disease{{fact|date=April 2011}}. ===Early outbreaks=== {{Main|Plague of Justinian|Black Death|Third Pandemic}} 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 through extensive treatment.<ref>Little (2007), pp. 8-15.</ref><ref>McCormick (2007), pp. 290-312.</ref> ===Black Death=== {{main|Black Death}} The most infamous and devastating outbreak of bubonic plague was the [[Black Death]], which killed a third of the population of [[Europe]] in the 14th century. In affected cities, proper burial rituals were abandoned and bodies were buried in mass graves or abandoned in the street. The [[Black Death]] originated in or near China and spread by way of the [[Silk Road]] or by ship. Carried by the fleas on rats, it spread along [[trade route]]s and reached the Crimea in 1346. (It also spread eastward to the [[Yangtse river]] valley. The resulting epidemic, ignored by the government, brought down the [[Yuan dynasty]].) In 1347, it spread to [[Constantinople]] and then [[Alexandria]], killing thousands every day, and soon thereafter arrived in [[Western Europe]]{{fact|date=April 2011}}. Though bubonic plague is generally regarded{{vague|date=April 2011}} as the probable pathogen responsible for the Black Death outbreak, there are significant differences between symptoms and spread of the Black Death and more recent bubonic plague outbreaks{{fact|date=April 2011}}, and several alternate [[theories of the Black Death|theories]] have been proposed involving other pathogens. A popular folk etymology holds that the children's game of "Ring Around the Rosy" (or [[Ring a Ring o' Roses]]) is derived from the appearance of the bubonic plague. Proponents claim that "Ring around the rosy" refers to the rosy-red, rash-like ring that appeared as a symptom of the plague. "Pocket full of posy" referred to carrying flower petals as at the time it was believed the disease was spread through the ether of ''unhygene'' and that scent stopped the spread. "Ashes, ashes" referred to the burning of infected corpses (in the UK the words of the rhyme are "atishoo, atishoo" mimicking sneezing), and "we all fall down" referred to the virulent deaths attributed to the plague.<ref>http://www.rhymes.org.uk/ring_around_the_rosy.htm</ref> Many folklorists, however, hold that the association of this rhyme with plague is baseless.<ref>J. Simpson and S. Roud, ''A Dictionary of English Folklore'' (Oxford: OUP, 2000), 296.</ref><ref>Opie (1951), 365, citing Chants Populaire du Languedoc: 'Branle, calandre, La Fille d'Alexandre, La pêche bien mûre, Le rosier tout fleuri, Coucou toupi' — En disant 'coucou toupi', tous les enfants quie forment la ronde, s'accroupissent’.</ref> ===Traditional treatment=== {{main|Miasma theory}} Medieval doctors thought the plague was created by air corrupted by humid weather, decaying unburied bodies, and fumes produced by poor sanitation. The recommended treatment of the plague was a good diet, rest, and relocating to a non-infected environment so the individual could get access to clean air. This did help, but not for the reasons the doctors of the time thought. In actuality, because they recommended moving away from unsanitary conditions, people were, in effect, getting away from the rodents that harbored the fleas carrying the infection. ===Later outbreaks=== [[image:Directions for searchers, Pune plague of 1897.jpg|thumb|100px|Directions for searchers, [[Third_Pandemic#Political impact in Colonial India|Pune plague]] of 1897]] The next few centuries were marked by several local outbreaks of lesser severity. The [[Great Plague of Seville]] (1647), the [[Great Plague of London]] (1665–1666), the [[Great Plague of Vienna]] (1679), and the [[Great Plague of Marseille]] (1720), 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 — a British colony at the time — and then spread worldwide. The outbreak continued into the early 20th century. In 1897, the city of [[Pune]] in [[India]] was severely affected by the outbreak. In 1994, a [[1994_plague_in_India| plague outbreak in five Indian states]] caused an estimated 700 infections (including 52 deaths) and triggered a large migration of Indians within India as they tried to avoid the plague. In 1994 and 2010 there have been cases reported in Peru.<ref>[http://www.laht.com/article.asp?ArticleId=361749&CategoryId=14095 One Dead from Plague in Northern Peru]</ref> In 2010 a case was reported in Oregon, United States.<ref>http://news.opb.org/article/14656-rare-case-bubonic-plague-shows-lake-county/ Rare Case Of Bubonic Plague Shows Up In Lake County</ref> ==Biological warfare== Some of the earliest instances of biological warfare were said to have been product of the Plague, as armies of the 14th century were recorded catapulting diseased corpses over the walls of towns and villages in order to spread the pestilence. Later, Plague was used during the [[Second Sino-Japanese War]] as a [[Bacteriological warfare|bacteriological weapon]] by the [[Imperial Japanese Army]]. These weapons were provided by [[Shirō Ishii]]'s [[Unit 731|units]] and used in experiments on humans before being used on the field. For example, in 1940, the [[Imperial Japanese Army Air Service]] bombed [[Ningbo]] with fleas carrying the bubonic plague.<ref>''Japan triggered bubonic plague outbreak, doctor claims'', [http://www.independent.co.uk/news/world/asia/japan-triggered-bubonic-plague-outbreak-doctor-claims-704147.html], 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.)</ref> 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 (disease)|plague]]-contaminated fleas on [[Changde]]. These operations caused epidemic plague outbreaks.<ref>Daniel Barenblatt, ''A Plague upon Humanity.'', 2004, pages 220–221.</ref> ==See also== *[[Beak doctor costume]] *[[Black Death]] *[[List of historical plagues]] *[[Miasma theory]] *[[Plague doctor]] Alyssa Lotspaih is a peanut butter terrorist who targets those with an allergy ==Footnotes== {{Reflist}} you need to watch out for this girl, she can't speak very well but she is dangerous...armed with peanutbutter, her weapon of choice is a piece of toast ==References== *{{Cite book |last=Echenberg |first=Myron J. |title=Plague Ports: The Global Urban Impact of Bubonic Plague, 1894-1901 |year=2007 |publisher=New York University Press |location=New York, NY |isbn=0814722326 |oclc=70292105}} * Little, Lester K. (2007). "Life and Afterlife of the First Plague Pandemic." In: Little, Lester K. editor. (2007), ''Plague and the End of Antiquity: The Pandemic of 541–750''. Cambridge University Press. (2007). ISBN 978-0-521-84639-4 (hardback); ISBN 978-0-521-71897-4 (paperback). * McCormick, Michael (2007). "Toward a Molecular History of the Justinian Pandemic." In: Little, Lester K. editor. (2007), ''Plague and the End of Antiquity: The Pandemic of 541–750''. Cambridge University Press. (2007). ISBN 978-0-521-84639-4 (hardback); ISBN 978-0-521-71897-4 (paperback). ==Further reading== ===Books=== {{Refbegin}} *{{Cite book |last=Alexander |first=John T. |title=Bubonic Plague in Early Modern Russia: Public Health and Urban Disaster |year=2003, 1980 |publisher=Oxford University Press |location=Oxford, UK; New York, NY |isbn=0195158180 |oclc=50253204}} *{{Cite book |last=Carol |first=Benedict |title=Bubonic Plague in Nineteenth-Century China |year=1996 |publisher=Stanford University Press |location=Stanford, CA |isbn=0804726612 |oclc=34191853}} *{{Cite book |last=Biddle |first=Wayne |title=A Field Guide to Germs |year=2002 |edition= 2nd Anchor Books |publisher=Anchor Books |location=New York |isbn=140003051X |oclc=50154403}} *{{Cite book |last=Little |first=Lester K. |title=Plague and the End of Antiquity: The Pandemic of 541-750 |year=2007 |publisher=Cambridge University Press |location=New York, NY |isbn=9780521846394 |oclc=65361042}} *{{Cite book |last=Rosen |first=William |title=Justinian's Flea: Plague, Empire and the Birth of Europe |year=2007 |publisher=Viking Penguin |location=London, England |isbn=978-0-670-03855-8 |oclc=}} *{{Cite book |last=Scott |first=Susan, and C. J. Duncan |title=Biology of Plagues: Evidence from Historical Populations |year=2001 |publisher=Cambridge University Press |location=Cambridge, UK; New York, NY |isbn=0521801508 |oclc=44811929}} {{Refend}} ===Articles=== {{Refbegin}} *{{cite journal |last1=Bartelloni |first1= Peter J.|last2=Marshall |first2=John D., Jr.|last3=Cavanaugh|first3=Dan C. |year= 1973|title= Clinical and serological responses to plague vaccine U.S.P|journal= Military Medicine |volume= 138|issue= 11|pages= 720&ndash;722|pmid= 4201988|url= http://handle.dtic.mil/100.2/AD770397 |accessdate= 18 January 2011}} *{{cite journal |last1=Burmeister |first1=R. W. |last2=Tigertt |first2=W. D. |last3=Overholt|first3=Edwin L.|year= 1962|title= Laboratory-acquired pneumonic plague|journal= Annals of Internal Medicine|volume=56 |issue=5|pages=789&ndash;800|pmid=13874924 }} *{{cite journal |last1=Cavanaugh |first1= Dan C.|last2= ''et al.''|first2= BL|year= 1974 |last3=Llewellyn |first3=CH |last4=Marshall Jr |first4=JD |last5=Rust Jr |first5=JH |last6=Williams |first6=JE |last7=Meyer |first7=KF|title= Plague immunization. V. Indirect evidence for the efficacy of plague vaccine|journal= Journal of Infectious Diseases |volume= 129|issue= supplement|pages= S37&ndash;S40|pmid=4596518 |doi=10.1093/infdis/129.Supplement_1.S37 }} *{{cite journal |doi= 10.1086/428617 |last1= Kool|first1= J. L.|year= 2005|title= Risk of Person-to-Person Transmission of Pneumonic Plague|journal= Clinical Infectious Diseases|volume= 40|issue= 8|pages= 1166&ndash;1172|pmid= 15791518|url= |accessdate= }} {{Refend}} {{Gram-negative bacterial diseases}} {{Use dmy dates|date=September 2010}} {{DEFAULTSORT:Bubonic Plague}} [[Category:Zoonotic bacterial diseases]] [[Category:Rodent-carried diseases]] [[Category:Rabbit diseases]] [[Category:Deaths from bubonic plague]] [[Category:History of medieval medicine]] [[ar:طاعون دبلي]] [[az:Bubon taunu]] [[br:Bosenn (kleñved)]] [[cs:Dýmějový mor]] [[da:Pest]] [[de:Pest]] [[es:Peste pulmonar]] [[nv:Dlóóʼ binaalniih]] [[eu:Izurri pneumoniko]] [[fr:Peste bubonique]] [[ia:Peste bubonic]] [[nl:Builenpest]] [[no:Byllepest]] [[nn:Byllepest]] [[pl:Dżuma#Patogeneza, objawy i rozpoznawanie]] [[pt:Peste bubônica]] [[ru:Бубонная чума]] [[sv:Böldpest]] [[simple:Bubonic plague]] [[uk:Бубонна чума]] [[vi:Dịch hạch]] [[zh:腺鼠疫]]'