References

http://en.wikipedia.org/wiki/Bubonic_plague
http://simple.wikipedia.org/wiki/Bubonic_plague
http://www.nlm.nih.gov/medlineplus/ency/article/000596.htm
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001622/
http://voices.yahoo.com/bubonic-plague-causes-symptoms-treatment-prevention-3986122.html
http://plague.emedtv.com/bubonic-plague/bubonic-plague-causes.html
http://rarediseases.about.com/cs/bubonicplague/a/111602.htm
http://plague.emedtv.com/bubonic-plague/bubonic-plague-transmission.html
http://www.cdc.gov/plague/diagnosis/index.html
http://health.nytimes.com/health/guides/disease/plague/overview.html
http://books.google.com.ph/books?id=YPJ5HPC4FPYC&pg=PT426&lpg=PT426&dq=nursing+intervention+of+bubonic+plague&source=bl&ots=u253S1HmYS&sig=zymlBPpDL4dxETNDTz3GVgEkNW4&hl=en&sa=X&ei=dFEnUf6CHdGeiQfLj4DgBQ&ved=0CCsQ6AEwADgU

Bubonic Plague Nursing Intervention

• Administer medications, I.V. fluids, and oxygen as ordered and needed.

•  Use standard precautions.

•  Provide adequate nutrition.

• Maintain a patent airway and adequate oxygenation.

•  Apply warm, moist compresses to buboes.

• Provide meticulous skin care.

• Prevent further injury to necrotic tissue areas.

• Institute seizure precautions.

•  Report suspected plague cases to local public health department.

Prevention of Bubonic Plague

Rat control and watching for the disease in the wild rodent population are the main measures used to control the risk of epidemics. A vaccination is available for high-risk workers, but its effectiveness is not clearly established.

There is no vaccine for the plague but there are measures that can help your body resist the plague if you've been exposed. These measures are only needed if you've been exposed to someone with the plague, have been bitten by a flea in an area known to have had recent plague outbreaks or plan to travel to an area known to have had recent plague outbreaks.

If you live in an area where plague outbreaks occur you may help prevent the plague by not coming into contact with sick or dead animals, rodent proofing your home, attempt to keep your pets flea free and take precautions such as insect repellent and watching children and pets closely while outdoors.

Treatment for Bubonic Plague

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. Using the broad-based antibiotic streptomycin has proven to be dramatically successful against the bubonic plague within 12 hours of infection.

Plague is a very serious illness, but is treatable with commonly available antibiotics. The earlier a patient seeks medical care and receives treatment that is appropriate for plague, the better their chances are of a full recovery.

People in close contact with very sick pneumonic plague patients may be evaluated and possibly placed under observation. Preventive antibiotic therapy may also be given, depending on the type and timing of personal contact.

If a doctor even thinks that you could have the bubonic plague you are immediately admitted to the hospital and put in an isolation room. You are then given very powerful antibiotics. These are administered either intravenously (through the veins) or intramuscularly (through the muscles). The antibiotics are given for a full 7 to 10 days. The most effective antibiotics used are called streptomycin and gentamicin. People who have been exposed to a person with the bubonic plague, even if they have no symptoms, still need to be treated with antibiotics. These antibiotics are oral, taken for 7 days and will help prevent the person from coming down with the plague.

People with the plague need immediate treatment. If treatment is not received within 24 hours of when the first symptoms occur, death may occur.

Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague. Oxygen, intravenous fluids, andrespiratory support usually are also needed.

Patients with pneumonic plague should be strictly isolated from caregivers and other patients. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

Diagnosis of Bubonic Plague

Plague is a plausible diagnosis for people who are sick and live in, or have recently traveled to, the western United States or any other plague-endemic area. The most common sign of bubonic plague is the rapid development of a swollen and painful lymph gland called a bubo. A known flea bite or the presence of a bubo may help a doctor to consider plague as a cause of the illness.

In many cases, particularly in septicemic and pneumonic plague, there are no obvious signs that indicate plague. Diagnosis is made by taking samples from the patient, especially blood or part of a swollen lymph gland, and submitting them for laboratory testing. Once plague has been identified as a possible cause of the illness, appropriate treatment should begin immediately.

Pathophysiology of Bubonic Plague

Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, Xenopsylla cheopis (the rat flea). In very rare circumstances, as in the septicemic plague, the disease can be transmitted by direct contact with infected tissue or exposure to the cough of another human. The fleas are often found on rodents such as rats and mice, and seek out other prey when their rodent hosts die. The bacteria began its life harmlessly living in the digestive tracts of mammals. The ability to propagate was dependent only upon its ability to travel from mammal host to mammal host. The bacteria remained harmless to the flea, allowing the new host to spread the bacteria. 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.

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 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.

Mode of Transmission of Bubonic Plague

Yersinia pestis (the bacteria that causes plague) is often found in animals such as rats and prairie dogs. Bubonic plague transmission usually occurs through bites from infected rodent fleas, direct contact with infected tissue or bodily fluids, or inhaling infected droplets. The disease is spread most commonly through the bites of infected fleas. Bubonic plague transmission from person to person is extremely rare.

An Overview of Bubonic Plague Transmission

Yersinia pestis is found in animals throughout certain parts of the world, most commonly in rats, but occasionally in other wild animals, such as prairie dogs.Plague transmission from these infected animals generally occurs in one of three ways:

·         Bites from infected rodent fleas

·         Direct contact with infected tissue or bodily fluids

·         Inhaling infected droplets.

Bubonic Plague Transmission Through Bites

Bubonic plague transmission to humans or animals is usually through the bites of infected rodent fleas (see Plague and Animalsfor other animals that can transmit plague). During rodent plague outbreaks, many animals die, and their hungry fleas seek out other sources of blood to survive. People and animals that visit places where rodents have recently died from plague risk being bitten by infected fleas.

This method of plague transmission accounts for about 85 percent of the human cases of plague.

House cats also are susceptible to plague. Infected cats become sick and may directly transmit plague to people who handle or care for them. Also, dogs and cats may bring plague-infected fleas into the home.

Bubonic Plague Transmission Through Inhaling Droplets

Inhaling droplets expelled by the coughing of a plague-infected person or animal (especially house cats) can result in plague of the lungs (a condition called pneumonic plague). Pneumonic plague transmission from person to person is uncommon, but sometimes results in dangerous epidemics that can spread quickly. However, this type of plague has not been seen in the United States since 1924.

Occurence of Bubonic Plague

Turns out, the plague isn’t just ancient history. New Mexico health officials recently confirmed the first human case of bubonic plague — previously known as the “Black Death” — to surface in the U.S. in 2011.

An unidentified 58-year-old man was hospitalized for a week after suffering from a high fever, pain in his abdomen and groin, and swollen lymph nodes, reports the New York Daily News. (Officials declined to say when the man was released from the hospital.) A blood sample from the man tested positive for the disease.

According to the World Health Organization, there are 1,000 to 3,000 cases of bubonic plague worldwide each year. There are no known cases in Australia or Europe. Areas where cases occur are in Russia, the Middle East, China, Southwest and Southeast Asia, Madagascar, southern and eastern Africa, the Andes mountains and Brazil.

The U.S. Centers for Disease Control and Prevention (CDC) reports that there are 10 to 15 cases of bubonic plague in the United States each year. These cases tend to occur in two regions: northern New Mexico, northern Arizona and southern Colorado; California, southern Oregon and far western Nevada.

Etiology of Bubonic Plague

The plague is caused by a bacteria named Yersinia pestis. The most common type of plague is the bubonic plague and is spread through flea bites. The bubonic plague is not common in humans. The bacteria usually infects squirrels, rabbits and prairie dogs. People who handle these animals, especially if the animals are wild, are at risk of being bit by their fleas which are carrying the bacteria. The bacteria can also enter a cut in the skin of a person who handles an infected animal. Domestic cats that are allowed to roam outside can come in contact with wild animals with the bacterial infection and then spread it to humans.

People can get the plague when they are bitten by a flea that carries the plague bacteria from an infected rodent. In rare cases, you may get the disease when handling an infected animal.

A plague lung infection called pneumonic plague can spread from human to human. When someone with pneumonic plague coughs, tiny droplets carrying the bacteria move through the air. Anyone who breathes in these particles may catch the disease. An epidemic may be started this way.

In the Middle Ages in Europe, massive plague epidemics killed millions of people. Plague can still be found in Africa, Asia, and South America.

Today, plague is rare in the United States, but it has been known to occur in parts of California, Arizona, Colorado, and New Mexico.

There three most common forms of plague are:

• Bubonic plague -- an infection of the lymph nodes
• Pneumonic plague -- an infection of the lungs
• Septicemic plague -- an infection of the blood

The time between being infected and developing symptoms is typically 2 to 7 days, but may be as short as 1 day for pneumonic plague.

Risk factors for plague include a recent flea bite and exposure to rodents, especially rabbits, squirrels, or prairie dogs, or scratches or bites from infected domestic cats.

Signs and Symptoms of Bubonic Plague

The most infamous symptom of bubonic plague is an infection of the lymph glands (lymphadenitis), which become swollen and painful and are known as buboes. After being transmitted via the bite of an infected flea the Y. pestis bacteria become localized in an inflamed lymph node where they begin to colonize and reproduce. Buboes associated with the bubonic plague are commonly found in the armpits, upper femoral, and groin and neck region. Acral gangrene (i.e. of the fingers, toes, lips and nose), is another common symptom.

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:

• Acral gangrene: Gangrene of the extremities such as toes, fingers, lips and tip of the nose.
• Chills
• General ill feeling (malaise)
• High fever (39 °Celsius; 102 °Fahrenheit)
• Muscle Cramps
• Seizures
• Smooth, painful lymph gland swelling called a buboe, 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 very extreme cases

Other symptoms include heavy breathing, continuous vomiting of blood (hematemesis), aching limbs, coughing, and extreme pain. The pain is usually caused by the decay or decomposition 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 Y. pestis plague are pneumonic and septicemic. Pneumonic plague, unlike the bubonic or septicemic, induces coughing and is very infectious, allowing it to be spread person to person.

Bubonic Plague Overview

A person with the bubonic plague has a serious infection caused by the bacteria, Yersinia pestis. The bacteria is transmitted to humans by rat flees, ticks and lice, but can also be spread from infected animals. The most common symptom is tender, swollen lymph glands. The bacteria can infect the skin, throat, lungs or brain. Bubonic plague is very rare: less than 10 cases of plague occur in the US each year.

What is bubonic plague?

Bubonic plague is a zoonotic disease, circulating mainly among small rodents and their fleas, and is one of three types of bacterial infections caused by Yersinia pestis (formerly known as Pasteurella pestis), which belongs to the family Enterobacteriaceae. Without treatment, the bubonic plague kills about two thirds of infected humans within 4 days.

The term bubonic plague is derived from the Greek word βουβών, meaning "groin." Swollen lymph nodes (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 Y. pestis—is generally believed to be the cause of the Black Death that swept through Europe in the 14th century and killed an estimated 25 million people, or 30–60% of the European population. 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.