Medication
Antibiotic treatment of bubonic plague is usually effective, but pneumonic plague is difficult to treat and even with antibiotic therapy death often results. A killed whole cell plague vaccine has been used in the past, but recent studies in animals have shown that this vaccine offers poor protection against pneumonic disease.
Would antibiotics work against plague?
Treatment. 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.
How do you cure plague?
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What is the cure for the plague?
Prescription antibiotics, such as penicillin, have helped people to recover from otherwise fatal diseases and conditions since the 1940s. However, people are also turning to natural antibiotics for treatment. According to the NHS, 1 in 10 people experiences side effects that harm the digestive system after taking antibiotics.
Is penicillin a good antibiotic?
Which medicine is best for plague?
TreatmentGentamicin.Doxycycline (Monodox, Vibramycin, others)Ciprofloxacin (Cipro)Levofloxacin.Moxifloxacin (Avelox)Chloramphenicol.
Can plague be cured with antibiotics?
Plague can be successfully treated with antibiotics. Once a patient is diagnosed with suspected plague they should be hospitalized and, in the case of pneumonic plague, medically isolated.
Which drug is used in plague?
Untreated plague can progress to a fulminant illness with a high risk of mortality. Thus, early and appropriate antibiotic treatment is essential. Historically, streptomycin (15 mg/kg, up to 1 g intramuscularly every 12 h) has been the drug of choice ; however, in the United States, supplies of streptomycin are scarce.
Can amoxicillin treat plague?
For the treatment of pneumonic plague, streptomycin, chloramphenicol, and the tetracyclines have demonstrated efficacy (11, 31). There are a number of antibiotics, including the quinolones, cephalosporins, ampicillin, amoxicillin, and rifampin, which demonstrate in vitro activity against Y.
Can penicillin cure the plague?
Penicillins, cephalosporins, and other antimicrobials are not considered effective for treatment of plague [14].
What is the plague?
Plague—a deadly disease caused by the bacterium Yersinia pestis —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 Y. pestisstrains 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 Y. pestishave 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.
What are the three main forms of plague?
Bubonic plague, septicemic plague and pneumonic plague are the three main clinical forms of this disease. Bubonic plague accounts for 70% to 90% of human cases, whereas the septicemic and pneumonic forms respectively account for around 30% and less than 5% [17,18,19,20,21,22]. It is noteworthy that the septicemic form is mainly diagnosed in USA because of the increasing standardized blood culture programs implemented in the country’s hospital laboratories [23]. The incubation period for plague is usually 2 to 3 days, although periods of 1 or even 5 days are not uncommon [17,24]. Regardless of the form of plague, the symptoms (fever, headache, general malaise, etc.) appear suddenly in most cases [17,24]. Furthermore, the disease progression is very rapid and usually fatal. However, the death rate is much lower for bubonic plague (40–60%) than for septicemic or pneumonic plague (>90% in both cases) [17,23]. Less commonly diagnosed clinical manifestations of plague included pestis minor (a benign form of bubonic plague), carbuncular plague with or without palpable buboes, gastric plague, and meningitis [25,26,27,28,29]. These minor forms of disease may reflect disease caused by atypical strains of Y. pestisor disease progression in immunocompromised patients and/or patients who receive inappropriate treatment [30,31,32].
What is the primary septicemic plague?
Primary septicemic plague is characterized by a fatal systemic infection in the absence of bubo production. Hence, the clinical picture is nonspecific, with general organ system failure. Histological and bacteriological analyses have revealed that 10% to 30% of mice bitten by infected fleas succumb to fatal bacteremia without developing a bubo [21,31,32,35]. Thus, the flea transmits both bubonic plague and primary septicemic plague. The more common bubonic plague results from the regurgitation of bacteria into the extravascular part of the dermis, whereas the less frequent primary septicemic plague results from the regurgitation of bacteria directly into the vascular part of the dermis and does not require the additional factors involved in the production of bubonic plague.
How many people died from the plague?
It has been estimated that plague caused more than 150 million deaths across the world. However, the number of plague cases has decreased over time. Plague killed hundreds of Europeans in the early 20th century, while it killed millions in the Middle Ages. In France, the last known case was recorded in 1945. It is therefore not surprising that many Europeans consider plague to be an ancient and extinct disease. However, this is not the case; 11 countries in sub-Saharan Africa, Asia, and the Americas reported around 3000 human cases of plague to the World Health Organization (WHO) between 2013 and 2018 [9]. Of these, Madagascar and the Democratic Republic of Congo accounted respectively for ~80% and ~15% of the world’s cases of plague.
When were antibiotics first used?
The premises of antibiotic therapy of infectious diseases go back a long way [42]. However, the idea of chemotherapy using purified or synthesized molecules only emerged just over a century ago (in 1911), when arsphenamine was used to treat syphilis. After this discovery and that of penicillin in 1928 [43], around 15 classes of antibiotics with different modes of action were described between 1932 and 1987; the 1940s, 1950s, and 1960s constituted the golden age of antibiotic discovery [44]. Although known compounds have been improved since then, the most recent class of antibiotic with activity against Gram-negative bacilli was introduced in the late 1980s [44].
What is the treatment for the plague?
Several clinical studies on treatment of plague in humans also have contributed to advancements in the field. A randomized controlled trial published in 2006 compared gentamicin with doxycycline for treatment of plague in Tanzania among 65 enrolled adults and children ( 17 ). Recent case series also have reported on the use of ciprofloxacin for treatment of bubonic and pneumonic plague in Uganda ( 18) and compared streptomycin with gentamicin for treatment of human plague in New Mexico ( 52 ).
What is the best treatment for bubonic plague?
Antimicrobials with demonstrated robust in vitro and in vivo activity against Y. pestis are preferred for treatment of bubonic and pharyngeal plague (Table 2). However, a notable difference in the recommendations for bubonic and pharyngeal disease is that doxycycline is considered a first-line treatment. Although certain studies have demonstrated reduced doxycycline efficacy for pneumonic plague ( 49, 67 ), doxycycline remains a safe and effective treatment for primary bubonic plague among patients who have not progressed to severe secondary septicemic or pneumonic plague. In a randomized clinical trial in Tanzania comparing gentamicin with doxycycline, 29 (97%) of 30 patients with bubonic plague survived after oral doxycycline treatment. The one death in the doxycycline group was attributed to advanced disease in a woman with a recent spontaneous abortion, a retained dead fetus, hemorrhage, and renal failure at the time treatment was initiated ( 17 ). Moreover, an analysis of U.S. surveillance data demonstrated that, among a subset of 45 patients with bubonic plague treated with tetracyclines and no other antimicrobial classes effective for plague, 44 (98%) survived ( 16) (Supplementary Appendix 1, https://stacks.cdc.gov/view/cdc/107427 ). On the basis of this demonstrated clinical efficacy and in vitro activity against Y. pestis ( 55, 76, 83 ), doxycycline is recommended as a first-line antimicrobial for treatment of patients with primary bubonic or pharyngeal plague.
How is pneumonic plague transmitted?
Pneumonic plague is the only clinical form that is transmissible from person to person ( 2, 9 ). Y. pestis is transmitted via large respiratory droplets that do not remain suspended in the air for prolonged periods. For this reason, health care providers should use respiratory droplet precautions when caring for patients with pneumonic plague ( 8 ). No evidence exists for airborne transmission of Y. pestis, as occurs with the measles virus or other pathogens that require airborne precautions to prevent exposure to others from an infected patient ( 2 ). Person-to-person transmission of Y. pestis requires exposure within 6 feet ( 2) and has been reported most commonly among an infected patient’s caregivers or others living together ( 10, 22 ).
What is the survival rate of a patient who received chloramphenicol?
Survival rates of patients who received chloramphenicol and sulfonamides, alone or in combination with other antimicrobials, were 78% (n = 25 of 32) and 65% (n = 28 of 43), respectively. When limited to patients who received monotherapy only, survival rates were 81% (n = 26 of 32) for aminoglycosides, 80% (n = 4 of 5) for fluoroquinolones, 83% (n = 5 of 6) for tetracyclines, 67% (n = 8 of 12) for chloramphenicol, and 50% (n = 13 of 26) for sulfonamides ( 19 ).
How does the Bubonic Plague affect humans?
The most common clinical presentation of plague in humans is bubonic plague ( 2, 3 ). Following the bite of an infected flea or direct contamination of a skin lesion, bacteria enter the host and are phagocytosed by macrophage and neutrophil cells ( 4 ). Surviving in macrophage cells, Y. pestis is then transported via lymphatics to regional lymph nodes ( 4, 5 ). Numerous antiphagocytic factors protect Y. pestis from human immune responses and allow reproduction and spread of the bacteria ( 6 ). Within the lymph node, the bacteria multiply, producing a tender swelling or “bubo” ( 5 ). Persons with bubonic plague might experience additional symptoms of fever, chills, malaise, and headache 2–8 days after initial infection ( 7 ). If not treated promptly, rapid multiplication of bacteria in the lymph nodes causes destruction of the lymph node architecture and necrosis. Hematogenous spread of bacteria might lead to secondary septicemic, pneumonic, or meningeal plague. Left untreated, the fatality rate of bubonic plague is 66%; however, with antimicrobial treatment, the fatality rate decreases substantially to 13% ( 3 ).
Is ciprofloxacin approved for human use?
Since the publication of plague guidelines in 2000, FDA has approved ciprofloxacin, levofloxacin, and moxifloxacin for treatment and prophylaxis of plague in humans on the basis of the Animal Rule ( 49 ). FDA can rely on adequate and well-controlled animal efficacy studies to support approval of a drug or licensure of a biologic product under the Animal Rule when human efficacy studies are not ethical and field trials are not feasible ( 50, 51 ).
When was the CDC's biodefense guidelines published?
On the basis of new developments, expert forum discussions, and other considerations, CDC made the following overarching changes compared with the guidelines published in 2000 by the Working Group on Civilian Biodefense ( 8 ):
What antibiotics are used for Y pestis?
This subsequently led to specific antibiotic prophylaxis and therapy for Y. pestis. The use of antibiotics such as tetracycline and streptomycin for the treatment of plague has been embraced by the World Health Organization Expert Committee on Plague as the 'gold standard' treatment.
What are some alternatives to antibiotics for Y pestis?
Several investigators have looked into the use of alternatives, such as immunotherapy, non-pathogen-specific immunomodulatory therapy, phage therapy, bacteriocin therapy, ...
Is the Yersinia pestis a biological weapon?
Plague still poses a significant threat to human health, and interest has been renewed recently in the possible use of Yersinia pestis as a biological weapon by terrorists. The septicaemic and pneumonic forms are always lethal if untreated.
What are the drugs used to treat a plague?
Select drug class All drug classes miscellaneous antibiotics (3) quinolones (11) tetracyclines (9) aminoglycosides (3) streptomyces derivatives (1) miscellaneous antimalarials (7) Rx. OTC. Off-label. Only Generics.
How is the plague passed on?
The third way the plague bacteria is passed on is when a patient with a plague infection of the lungs (pneumonic plague) coughs or breathes out small particles containing bacteria and another person then inhales those bacteria into their own lungs. Once infected with the plague it can show as different forms.
What is the rarest form of the plague?
Septicemic plague is the rarest form of the plague and occurs when bacteria spreads into the blood stream either from infection from a flea bite or infected through broken skin by direct contact with infected animals.
What is the name of the disease caused by a bacteria that is found on fleas?
Medications for Plague. Other names: Bubonic plague; Pneumonic plague; Septicemic plague. The plague is an infection caused by a bacteria Yersinia pestis which is found on fleas, that live on small animals. The bacteria can be passed to a new host in three ways. The first way is when an infected flea moves to a new host and bites it, ...
Why does the bubonic plague hurt?
Bubonic plague usually is due to being infected from the bite from an infected flea. Once bitten the bacteria travels from the infection site through the lymph system to the nearest lymph node. At the lymph node the bacteria replicates itself causing enlarged, inflamed and painful lymph node.
What happens when the septicemic plague spreads?
As septicemic plague progresses the blood can no longer clot causing bleeding into the skin and vomiting or spitting up blood.
Can the septicemic plague be fatal?
If it is not treated septicemic plague is usually fatal. Pneumonic plague can occur as a progression of bubonic plague, when the bacteria travels from the infected lymph gland to the lung tissue. Pneumonic plague can also be passed from person-to-person by inhaling infected droplets from a patient with pneumonic plague.
What is the bubonic plague?
Bubonic plague is a bacterial infection caused by the bacteria Yersinia pestis which can be effectively treated with antibiotics. If bubonic plague is left untreated, the infection can spread and progress to septicemic plague and may even infect the lungs to become secondary pneumonic plague.
How long does it take for antibiotics to work?
Antibiotic treatment is usually 10 to 14 days, or until 2 days after the fever has finished.
Can bubonic plague be treated?
Bubonic plague can successfully be treated with specific antibiotics. If bubonic plague is not treated, the infection can lead to serious complications including death. References. CDC Plague Information for Healthcare Professionals https://www.cdc.gov/plague/healthcare/clinicians.html.
What happens if the Bubonic Plague isn't treated?
What happens if bubonic plague isn’t treated? Bubonic plague can be fatal if it’s not treated. It can create infection throughout the body (septicemic plague) and / or infect your lungs (pneumonic plague.) Without treatment, septicemic plague and pneumonic plague are both fatal.
How to diagnose bubonic plague?
To diagnose bubonic plague, your healthcare provider will order blood or tissue sample tests. The samples will be sent to the lab for testing to see if Y. pestis is present.
How long does it take for a bubonic plague to go away?
Symptoms usually develop two to six days after exposure. The best recovery happens if you are treated within 24 hours of developing symptoms. You’ll probably feel better after one to two weeks. However, untreated bubonic plague can be fatal.
What are the symptoms of the septicemic plague?
Sudden high fever and chills. Pains in the areas of the abdomen, arms and legs. Headaches. Large and swollen lumps in the lymph nodes (buboes) that develop and leak pus. Symptoms of septicemic plague may include blackened tissue from gangrene, often involving the fingers or toes, or unusual bleeding.
What is the name of the disease caused by a specific type of bacterium called Yersinia?
Plague is an infectious disease caused by a specific type of bacterium called Yersinia pestis. Y. pestis can affect humans and animals and is spread mainly by fleas. Bubonic plague is one type of plague. It gets its name from the swollen lymph nodes (buboes) caused by the disease. The nodes in the armpit, groin and neck can become as large as eggs ...
What are the different types of plagues?
The other types of plague are: 1 Septicemic plague, which happens when the infection goes all through the body. 2 Pneumonic plague, which happens when lungs are infected.
How did the plague get its name?
It gets its name from the swollen lymph nodes (buboes) caused by the disease. The nodes in the armpit, groin and neck can become as large as eggs and can ooze pus. The other types of plague are: Septicemic plague, which happens when the infection goes all through the body.
What antimicrobials are effective for plague?
In addition to aminoglycosides, other classes of antimicrobials including tetracyclines, fluoroquinolones, and sulfonamides are effective for plague treatment, although publication bias and low numbers in certain treatment groups may limit interpretation.
What is the Yersinia pestis?
Yersinia pestis causes a life-threatening infection that typically manifests as bubonic, pneumonic, or septicemic plague [ 1, 2 ]. This zoonotic disease earned the moniker “Black Death” during widespread epidemics in the Middle Ages due to its high fatality rate and propensity to cause severe, dusky necrosis of the extremities and skin [ 3 ]. Humans contract Y. pestis via flea bite, handling or ingestion of infected tissues, or inhalation of contaminated droplets from infected humans or animals [ 1 ]. Plague remains endemic in specific regions of Africa, Asia, and the Americas and continues to cause naturally occurring outbreaks and sporadic cases among humans [ 4–8 ]. A 2017 outbreak in Madagascar caused 98 cases of confirmed pneumonic (n = 32) and bubonic (n = 66) plague with a 24% case fatality rate (CFR), underscoring the ongoing risk in endemic areas [ 9 ].
Can antimicrobials be used to treat the plague?
This systematic literature review supports the notion that antimicrobials from several distinct classes can be used to treat plague successfully. Specifically, patients with plague described in the literature had similar CFRs when treated with tetracyclines and aminoglycosides, as well as with the more recently available fluoroquinolones. CFRs of patients treated with sulfonamides were slightly higher but likely confounded by time period, as sulfonamides were primarily used for treatment of plague in the 1930s and 1940s when medical treatments and supportive care were less advanced.
