IF SYMPTOMS PERSIST
“Whole nations annihilated… the vast cities of America, the fertile plains of Hindostan, the crowded abodes of the Chinese, are menaced with utter ruin.”— Mary Shelley (1797-1851), English novelist, The Last Man (1826)
Mary Shelley, best known for the Gothic novel “Frankenstein or The Modern Prometheus,”(1811) also wrote “The Last Man” (1826). It is her dystopian, apocalyptic science fiction work that merits a second look in these unusual times. A global plague began in 2092 and it razed “the vast cities of America … and the crowded abodes of the Chinese.” By the time the pestilence ended, only Lionel Verney, Shelley’s alter ego was alive – and it was 2100.
Yersinia pestis. Now as if mankind’s hands aren’t full handling the coronavirus pandemic, a new threat was reported fromBayannur, a city in Inner Mongolia (yes, of the People’s Republic of China). A herdsman has been infected with bubonic plague –the one that caused the deadliest recorded pandemic- The Black Death in medieval Europe (1346-1353). Up to 200 million lives were lost.The plague is caused by wild rodents (rats, marmots, squirrel, prairie dogs) that are infected with fleas with the ancient bacteria Yersinia pestis.The infection is transmitted to humans by a flea bite or through an unfortunate break in the skin.Human to human transmission occurs by inhaling droplets from the cough or sneeze of an infected person.
Signs & Symptoms. The plaguehasfour known forms. The most common is the bubonic plague with an incubation period of 2 to 5 days. High fever (39.5 to 41C) and chills ensue.Lymph nodes draining the site of inoculation become tender and prominent, often bursting in the 2nd week. The patient becomes restless and delirious and if left untreated, mortality reaches60%. The second type is pneumonic plagueor infection of the lungs in which just 2 to 3 days is needed to develop a productive, blood-speckled cough. Breathing becomes fast and labored and without treatment, a person can die in 48 hours.Septicemic plague affects the blood with 40% of patients showing nausea, vomiting, abdominal pain and diarrhea. Blood clots form causing gangrene of the extremities, turning them blue to black (hence, “Black Death”). Multi-organ failure results and can be fatal ahead of bubonic or lung signs.The most benign form is pestis minor. Found only in endemic areas, the patient shows lymph node inflammation, fever, headache, and extreme fatigue. However, these may last for just a week.
Diagnosis. The patient’s blood, sputum, or pus from the infected lymph nodes are taken as samples. Detecting the DNA of the bacteria is determined by the PCR (polymerase chain reaction) test. In pneumonic plague, chest xrays will show rapid progression of pneumonia.
Treatment& Prevention. Patients with bubonic plague are routinely isolated. The antibiotics of choice are streptomycin and gentamicin. Alternatively,other antibiotics -doxycycline, ciprofloxacin, levofloxacin and chloramphenicol are used. Travelers are given doxycycline as prophylaxis during exposure periods. Contact tracing should be done and suspected individuals may be given prophylactic antibiotics for 7 days. Finally, control rodents and repellents against fleas.At this time, there is no cause for alarm. And unlike the novel virus, the bubonic plague is an old enemy and we know it well. Its dominion is historical and the fear of it now largely imagined.
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