A 15 year old boy died from bubonic plague in Kyrgyzstan last week. Purportedly, his was the first known case in the country for 30 years. It was suspected that the boy, who was a herder, was bitten by a flea. It was also reported that the boy ate barbequed marmot while camping in the mountains. Marmots have been known to carry the plague along with many other rodents such as rats, mice, squirrels, and prairie dogs. Since the boy’s post-mortem diagnosis, at least 100 individuals, believed to be at risk, have been quarantined. Due to the dangerous nature of the disease, precautions are being taken in nearby Kazakhstan. These measures include thinning local rat populations and mass vaccination in ‘territories of habitation of disease carriers’. To add to the bit of hysteria in the region, China refused to send athletes to a meet in Kazakhstan.
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This ‘plague’ is indeed the same affliction responsible for wiping out an estimated 60 percent of Europe’s population in the Middle Ages. Although there have been a number of devastating plagues throughout history, the plague of the Middle Ages or the ‘Black Death’, is perhaps most responsible for shaping the history of modern civilization. With no cure or known cause, the plague periodically terrorized entire populations until germ theory arose and later, the advent of antibiotics. Today, the plague maintains a small bacterial reservoir in rodent populations mostly in the Western United States, Asia, and Africa.
Plague is caused by the bacteria Yersinia pestis and is carried in both rodents and rodent fleas. If treated, individuals can make a full recovery. However, due to the rarity of the disease today, death occurs in cases left undiagnosed or improperly treated.
According to the CDC, plague, which is caused when a person is infected with the bacteria Yersinia pestis, can be transmitted in three ways: flea bites (bubonic plague or septicemic plague), contact with contaminated fluid or tissue (bubonic plague or septicemic plague), or infectious droplets (pneumonic plague). Although a variety of clinical symptoms can manifest, bubonic, septicemic, and pneumonic are the most common forms.
Bubonic plague, as was the case in Kyrgyzstan, does not exhibit the black skin that can occur in advanced cases of septicemic plague, but can be identified by the swelling of lymph nodes. From the CDC:
‘Patients develop sudden onset of fever, headache, chills, and weakness and one or more swollen, tender and painful lymph nodes (called buboes). This form usually results from the bite of an infected flea. The bacteria multiply in the lymph node closest to where the bacteria entered the human body. If the patient is not treated with the appropriate antibiotics, the bacteria can spread to other parts of the body.’
Although the plagues of yore are long gone thanks to modern medicine, the plague may always be a small threat to the world. If left diagnosed, a single case of the plague can spread from one person to another. If untreated, it can, and in rare cases still does, kill. The best way to evade transmission is to avoid rodent carriers in endemic areas, which includes handling and consumption. Antibiotic treatment and quarantine is available protect the world from future outbreaks. While under the International Health Regulations WHO member states are required to report human cases of plague, the WHO estimates that human cases remain underreported due to lack of testing facilities and non-specific clinic symptoms.