This document summarizes the history and key details of plague (also known as the Black Death). It discusses three main points: 1. The history of plague pandemics, beginning in ancient times and including the devastating Black Death pandemic of the 14th century that killed around half of Europe's population. 2. The causative bacteria (Yersinia pestis) and how it is typically transmitted from infected rodents and their fleas to humans. 3. The three main forms of plague - bubonic, septicemic, and pneumonic - along with their symptoms, diagnosis, treatment, and methods of prevention.

1. This is the
traditional
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2. Plague
Dr. Akhiruzzaman
Assistant Professor and Head of Community Medicine
Diabetic Association Medical College, Faridpur

3. As late as 1768 the first edition of
the Encyclopædia Britannica repeated the
commonly held scientific notion that plague
was a “pestilential fever” arising from a
“poisonous miasma,” or vapour, that had
been brought “from eastern countries” and
was “swallowed in with the air.”

4. History
Plague is an ancient disease that was described
during Classical times as occurring in North Africa
and the Middle East.
Unequivocal evidence for its early existence comes
from the discovery of genomic traces of Y. pestis in
the teeth of Neolithic farmers in Sweden dated to
roughly 4,900 years ago and from analyses of
ancient DNA in the teeth of Bronze Age humans,
which indicate that Y. pestis was present in Asia and
Europe by between 3000 and 800 BC.
However It is nearly impossible to verify the true
nature of these early outbreaks.

5. The first great plague pandemic to be reliably
reported occurred during the reign of the Byzantine
emperor Justinian-I in the 6th century.
According to the historian Procopius and others,
the outbreak began in Egypt and moved along
maritime trade routes, striking Constantinople in
542 BC.
There it killed residents by the tens of thousands,
the dead falling so quickly that authorities had
trouble disposing of them.
Over the next half-century, the pandemic spread
westward to port cities of the Mediterranean and
eastward into Persia.

6. Overland trade routes
maritime trade routes

7. The next great plague pandemic was named
as Black Death and reported in Europe on
14th century.
It has been calculated that one-fourth to one-
third of the total population of Europe, or 25
million persons, died from plague during the
Black Death.
For the next three centuries, outbreaks of
plague occurred frequently throughout the
continent and the British Isles. In total about
50 million death occurred around the world

8. The Great Plague of London of 1664–66
caused between 75,000 and 100,000 deaths in
a population estimated at 460,000.
Plague raged in Cologne and on the Rhine
river from 1666 to 1670 and in the
Netherlands from 1667 to 1669, but after that
it seems to have subsided in western Europe.
Malta lost 11,000 persons in 1675, Vienna at
least 76,000 in 1679, and Prague 83,000 in
1681.

9. Between 1675 and 1684 a new outbreak
appeared in North Africa, Turkey, Poland,
Hungary, Austria, and Germany, progressing
northward.
Many northern German cities also suffered
during this time, but in 1683 plague
disappeared from Germany. France saw the last
of plague in 1668, until it reappeared in 1720 in
the port city of Marseille, where it killed as
many as 40,000 people.

10. Once it was a maxim that plague never appeared
east of the Indus River, but during the 19th
century it afflicted more than one district of
India: in 1815 Gujarat, in 1815 Sind, in 1823 the
Himalayan foothills, and in 1836 Rajasthan.
These outbreaks merely set the stage for the
third great plague pandemic, which is thought
to have gained momentum in Yunnan province,
southwestern China, in the 1850s and finally
reached Guangzhou (Canton) and Hong Kong in
1894.

11. • These port cities became plague-distribution
centres, and between 1894 and 1922 the disease
spread throughout the whole world
• more widely than in any preceding pandemic,
resulting in more than 10 million deaths.
• Among the many points infected were Bombay in
1896, Calcutta in 1898, Cape Town and San
Francisco in 1900, Bangkok in 1904, Guayaquil
(Ecuador) in 1908, Colombo (Sri Lanka) in 1914,
and Pensacola (Florida) in 1922.
• Almost all the European ports were struck, but, of
all the areas affected, India suffered the most.

12. Disease causation
• The bacteria that cause plague, Yersinia pestis,
maintain their existence in a cycle involving
rodents and their fleas.
• Plague bacteria circulate at low rates within
populations of certain rodents without causing
excessive rodent die-off.
• Occasionally, other species become infected,
causing an outbreak among animals, called an
epizootic. Humans are usually more at risk
during, or shortly after, a plague epizootic.

14. • Reservoir: Infected rodents, fleas and human
• Source of infection: Infectious lymph node, blood
or sputum.
• Mode of transmission:
a. the bite of infected vector (fleas)
b. unprotected contact with infectious bodily
fluids or contaminated materials
c. the inhalation of respiratory droplets/small
particles from a patient with pneumonic plague.
• IP: The incubation period for bubonic plague lasts
an average of 1-7 days, primary pneumonic plague
usually has a shorter incubation period, averaging
1 - 4 days.

15. Types of plague
There are 3 main forms of plague:
1. Bubonic plague
2. Septicaemic plague
3. Pneumonic plague

16. Bubonic plague
• Bubonic plague is the most common and is
caused by the bite of an infected flea.
• The plague bacillus, enters at the bite and
travels to the nearest lymph node to replicate.
• The lymph node becomes inflamed, tense and
painful, and is called a bubo.
• With advanced infections, the inflamed lymph
nodes can turn into suppurating open sores.
• Bubonic plague cannot be transmitted from
human to human.

18. Septicaemic plague
• Septicaemic plague occurs when infection
spreads through the bloodstream.
• It may result from flea bites or from direct
contact with infective materials through cracks
in the skin.
• Advanced stages of the bubonic form of
plague will also lead to direct spread of Y.
pestis in the blood.

20. Pneumonic plague
• Pneumonic plague – or lung-based plague – is
the most virulent and least common form of
plague.
• Typically, it is caused by spread to the lungs
from advanced bubonic plague.
• A person with pneumonic plague may form
aerosolized infective droplets and transmit
plague to other humans.
• This is usually fatal.

21. Diagnosis
• Identify Y. pestis from a sample of pus from a
bubo, blood or sputum. (Direct microscopic
examination or culture)
• A specific Y. pestis antigen can be detected by
a laboratory validated rapid dipstick test
• Polymerase chain reaction (PCR) may also be
used to diagnose plague (by detecting the
presence of bacterial genes such as the pla
gene (plasmogen activator) and caf1 gene, (F1
capsule antigen)

22. Treatment
• Antibiotics and supportive therapy are
effective against plague if patients are
diagnosed in time.
• Pneumonic plague can be fatal within 18 to 24
hours of disease onset if left untreated, but
common antibiotics for enterobacteria (gram
negative rods) can effectively cure the disease.

23. Prevention
• Preventive measures include informing people when
zoonotic plague is present in their environment and
advising them to take precautions against flea bites
and not to handle dead animal.
• Generally people should be advised to avoid direct
contact with infected body fluids and tissues. When
handling potentially infected patients and collecting
specimens, standard precautions should apply.
Vaccination
• WHO does not recommend vaccination, except high-
risk groups (such as laboratory personnel who are
constantly exposed to the risk of contamination, and
health care workers).

24. •A plague doctor was a
physician who treated
victims of bubonic plague
during epidemics.
•These physicians were
hired by cities to treat
infected patients
regardless of income,
especially the poor that
could not afford to pay
Plague doctor

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