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The American Journal of Medicine Feb 2021During the fourteenth century, the bubonic plague or Black Death killed more than one third of Europe or 25 million people. Those afflicted died quickly and horribly... (Review)
Review
During the fourteenth century, the bubonic plague or Black Death killed more than one third of Europe or 25 million people. Those afflicted died quickly and horribly from an unseen menace, spiking high fevers with suppurative buboes (swellings). Its causative agent is Yersinia pestis, creating recurrent plague cycles from the Bronze Age into modern-day California and Mongolia. Plague remains endemic in Madagascar, Congo, and Peru. This history of medicine review highlights plague events across the centuries. Transmission is by fleas carried on rats, although new theories include via human body lice and infected grain. We discuss symptomatology and treatment options. Pneumonic plague can be weaponized for bioterrorism, highlighting the importance of understanding its clinical syndromes. Carriers of recessive familial Mediterranean fever (FMF) mutations have natural immunity against Y. pestis. During the Black Death, Jews were blamed for the bubonic plague, perhaps because Jews carried FMF mutations and died at lower plague rates than Christians. Blaming minorities for epidemics echoes across history into our current coronavirus pandemic and provides insightful lessons for managing and improving its outcomes.
Topics: COVID-19; History, Medieval; Humans; Pandemics; Plague
PubMed: 32979306
DOI: 10.1016/j.amjmed.2020.08.019 -
Genes and Immunity May 2019Plague is a vector-borne disease caused by Yersinia pestis. Transmitted by fleas from rodent reservoirs, Y. pestis emerged <6000 years ago from an enteric bacterial... (Review)
Review
Plague is a vector-borne disease caused by Yersinia pestis. Transmitted by fleas from rodent reservoirs, Y. pestis emerged <6000 years ago from an enteric bacterial ancestor through events of gene gain and genome reduction. It is a highly remarkable model for the understanding of pathogenic bacteria evolution, and a major concern for public health as highlighted by recent human outbreaks. A complex set of virulence determinants, including the Yersinia outer-membrane proteins (Yops), the broad-range protease Pla, pathogen-associated molecular patterns (PAMPs), and iron capture systems play critical roles in the molecular strategies that Y. pestis employs to subvert the human immune system, allowing unrestricted bacterial replication in lymph nodes (bubonic plague) and in lungs (pneumonic plague). Some of these immunogenic proteins as well as the capsular antigen F1 are exploited for diagnostic purposes, which are critical in the context of the rapid onset of death in the absence of antibiotic treatment (less than a week for bubonic plague and <48 h for pneumonic plague). Here, we review recent research advances on Y. pestis evolution, virulence factor function, bacterial strategies to subvert mammalian innate immune responses, vaccination, and problems associated with pneumonic plague diagnosis.
Topics: Animals; Evolution, Molecular; Humans; Plague; Virulence Factors; Yersinia pestis
PubMed: 30940874
DOI: 10.1038/s41435-019-0065-0 -
Biomolecules May 2021Plague-a deadly disease caused by the bacterium -is still an international public health concern. There are three main clinical forms: bubonic plague, septicemic plague,... (Review)
Review
Plague-a deadly disease caused by the bacterium -is still an international public health concern. There are three main clinical forms: bubonic plague, septicemic plague, and pulmonary plague. In all three forms, the symptoms appear suddenly and progress very rapidly. Early antibiotic therapy is essential for countering the disease. Several classes of antibiotics (e.g., tetracyclines, fluoroquinolones, aminoglycosides, sulfonamides, chloramphenicol, rifamycin, and β-lactams) are active in vitro against the majority of strains and have demonstrated efficacy in various animal models. However, some discrepancies have been reported. Hence, health authorities have approved and recommended several drugs for prophylactic or curative use. Only monotherapy is currently recommended; combination therapy has not shown any benefits in preclinical studies or case reports. Concerns about the emergence of multidrug-resistant strains of have led to the development of new classes of antibiotics and other therapeutics (e.g., LpxC inhibitors, cationic peptides, antivirulence drugs, predatory bacteria, phages, immunotherapy, host-directed therapy, and nutritional immunity). It is difficult to know which of the currently available treatments or therapeutics in development will be most effective for a given form of plague. This is due to the lack of standardization in preclinical studies, conflicting data from case reports, and the small number of clinical trials performed to date.
Topics: Animals; Anti-Bacterial Agents; Host Microbial Interactions; Humans; Immunotherapy; Plague; Vaccines; Yersinia pestis
PubMed: 34065940
DOI: 10.3390/biom11050724 -
British Medical Bulletin 1998Yersinia pestis, the aetiological agent of plague, has in the past caused social devastation on a scale unmatched by other infectious diseases. There is still a public... (Review)
Review
Yersinia pestis, the aetiological agent of plague, has in the past caused social devastation on a scale unmatched by other infectious diseases. There is still a public health problem from plague, with at least 2000 cases reported annually. Most of these cases are of the bubonic form. Occasionally bubonic plague develops into pneumonic plague, and this form of the disease can spread rapidly between susceptible individuals. The recent outbreak of plague in India highlighted the potential for plague to explosively re-appear, and modern mass transport systems mean that there is the potential for the rapid spread of disease. Against this background, there is a need to ensure that vaccines and antibiotics are available to prevent and treat the disease. Progress has been made in devising a sub-unit vaccine, effective against bubonic and pneumonic plague. Antibiotics must be given in the early stages of disease to effect a cure.
Topics: Disease Outbreaks; Disease Reservoirs; Humans; Incidence; Plague
PubMed: 10326289
DOI: 10.1093/oxfordjournals.bmb.a011715 -
Seminars in Respiratory Infections Sep 2003Pneumonic plague, a disease caused by the bacterium Yersinia pestis, is a rare disease in the United States and carries a high mortality. Health care professionals in... (Review)
Review
Pneumonic plague, a disease caused by the bacterium Yersinia pestis, is a rare disease in the United States and carries a high mortality. Health care professionals in the United States are not familiar with the clinical presentation and diagnosis of plague pneumonia. The wide prevalence of the bacterium in different parts of the world, its high virulence, and its ability to spread by aerosolization makes it a potential agent of biological warfare in the hands of terrorists. This review focuses on the prevalence, pathogenesis immunity, clinical manifestations, diagnosis, treatment, and prevention of plague pneumonia, with particular emphasis on the plague bacillus as an agent of biological warfare. Based on available information, we discuss measures that need to be undertaken by health care personnel, public health personnel, and epidemiologists in the event of such an attack.
Topics: Anti-Infective Agents; Bioterrorism; Humans; Plague; United States; Yersinia pestis
PubMed: 14505278
DOI: No ID Found -
Releve Epidemiologique Hebdomadaire Apr 2005
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Medical History. Supplement 2008
Review
Topics: Animals; Arthropod Vectors; Epidemics; Humans; Mammals; Plague; Siphonaptera; Terminology as Topic; Yersinia pestis
PubMed: 18575085
DOI: No ID Found -
BMJ (Clinical Research Ed.) Jan 2020
Topics: China; Communicable Disease Control; Humans; Infection Control; Plague; Public Health; Yersinia pestis
PubMed: 31911406
DOI: 10.1136/bmj.l7072 -
Trends in Microbiology Mar 2016Inhalation of the bacterium Yersinia pestis results in primary pneumonic plague. Pneumonic plague is the most severe manifestation of plague, with mortality rates... (Review)
Review
Inhalation of the bacterium Yersinia pestis results in primary pneumonic plague. Pneumonic plague is the most severe manifestation of plague, with mortality rates approaching 100% in the absence of treatment. Its rapid disease progression, lethality, and ability to be transmitted via aerosol have compounded fears of the intentional release of Y. pestis as a biological weapon. Importantly, recent epidemics of plague have highlighted a significant role for pneumonic plague during outbreaks of Y. pestis infections. In this review we describe the characteristics of pneumonic plague, focusing on its disease progression and pathogenesis. The rapid time-course, severity, and difficulty of treating pneumonic plague highlight how differences in the route of disease transmission can enhance the lethality of an already deadly pathogen.
Topics: Animals; Biological Warfare Agents; Disease Progression; Humans; Lung; Plague; Virulence; Yersinia pestis
PubMed: 26698952
DOI: 10.1016/j.tim.2015.11.008 -
La Revue de Medecine Interne Nov 2018Plague is a bacterial zoonosis caused by Yersinia pestis, usually found in fleas and small rodents that constitute the reservoir of the disease. It is transmitted to... (Review)
Review
Plague is a bacterial zoonosis caused by Yersinia pestis, usually found in fleas and small rodents that constitute the reservoir of the disease. It is transmitted to humans by flea bite, contact with rodents or inhalation of infected droplets. There are three clinical forms: bubonic plague, pulmonary plague and septicemic plague. The usual presentation is a flu-like syndrome possibly accompanied by an inflammatory lymphadenopathy which appears after 1 to 7days of incubation. Bubonic plague has a case fatality rate of about 50% while other forms of plague are almost always fatal without treatment. Diagnosis can be confirmed by usual bacteriological techniques (Gram examination, culture) but also by serological examination, use of rapid diagnostic tests or PCR. Although aminoglycosides are traditionally regarded as the most effective treatment, fluoroquinolones or cyclins are currently recommended in France. Plague is one of the re-emerging diseases according to the WHO and Madagascar suffered in 2017 the most important plague epidemic of the 21st century with more than 2000 cases and 200 deaths. Peru and the Democratic Republic of Congo are also considered endemic areas. Public health measures and a relentless fight against poverty are the cornerstone of the control of the disease. Vaccine improvement in endemic areas may also play an important role.
Topics: Animals; Anti-Bacterial Agents; France; Humans; Plague; Siphonaptera; Yersinia pestis
PubMed: 29628173
DOI: 10.1016/j.revmed.2018.03.019