If the word plague gets your attention, it should. Responsible for wiping out a lot of the earth’s population, we are still terrified to hear about it.
We now know that bacteria was responsible for the plague, and it has a name. Yersinia pestis. Today plague is uncommon, recognizable, and treatable with antibiotics.
The story developing in Siberia involves a young laboratory worker. One story says she broke a vial that contained live Yersinia pestis. She died quickly. Russian officials say of pneumonia of uncertain origin. About 200 people were placed under observational quarantine.
So before we decide the Black Death has returned, let’s separate the biology from the headlines.
The three forms of black death
When we talk about the plague, we have divided it into three types. Bubonic plague, septicemic plague, and pneumonic plague. All of them are caused by the same organism, and all of them treatable with antibiotics. But they manifest differently.
Bubonic plague is the form most people associate with the Black Death. These bacteria usually enter through an infected flea bite and travel to nearby lymph nodes. Lymph nodes turn dark or black because of internal bleeding and dead tissue. They become large and painful, and we have a unique name for them. We call these lymph nodes “buboes”. Without treatment, about 30 to 60 percent of people will die. Person-to-person transmission of bubonic plague itself is uncommon.
Pneumonic plague is the form relevant to the current concern in Siberia. This form of plague infects the lungs and can progress quickly. Symptoms include fever, profound illness, shortness of breath and cough, sometimes with bloody sputum. Pneumonic plague spreads directly from person to person through respiratory particles during close exposure. Untreated, it can be fatal within 18 to 24 hours after even minor symptoms begin.
Septicemic plague occurs when the bacteria multiply in the bloodstream. Patients rapidly develop shock, along with bleeding, tissue necrosis and organ failure. Untreated septicemic plague is fatal. This is usually the final step before death, and often started as bubonic or pneumonic plague.
That is why plague is one of those infections where physicians treat before we have the final test result.
The CDC states that if plague is suspected, besides the usual, obtaining cultures is to begin antibiotics immediately.
In the United States, gentamicin and fluoroquinolones are the recommended antibiotics used for 10 to 14 days.
The World Health Organization recommends close contacts be identified, monitored, and given seven days of preventive antibiotics. Healthcare workers directly exposed to pneumonic plague patients also receive antibiotics.
That explains some of what we are seeing in Russia.
A 28-year-old woman working in a laboratory in Irkutsk developed a rapidly progressive pneumonia and died. Something all sources agree upon. However, one report says she broke a vial containing live Yersinia pestis. Russian federal officials say she died from pneumonia of uncertain origin, and no work-related pathogen was identified.
Meanwhile, about 200 people who had contact with her were placed under observation, and several hospitals went into quarantine. Quarantining a hospital does not mean everyone in the hospital has plague or been exposed to it. If authorities believe someone has had a pneumonic plague, they can trace and isolate contacts while they sort out what happened. And of course, begin antibiotics.
Biologic Weapons - not a conspiracy
The Soviet Union had a large biological-weapons program. Former program officials said some of the work with Yersinia pestis included efforts to produce antibiotic-resistant strains.
We do not know if this woman was exposed to a resistant or “engineered” strain. But if a plague was involved in a laboratory accident, one of the first questions I would want answered is which strain was it, and what antibiotics is it susceptible to?
Unlike what terrified medieval Europe, we have antibiotics, laboratories, infection control, contact tracing, and the ability to recognize what we are looking at. Not just a mask with some incense.
Just in Time for Halloween
For more information, see below:
