Tag Archives: Bacterial

Strep throat

Other Names:
Streptococcal pharyngitis, streptococcal tonsillitis, or streptococcal sore throat

Definition:
Strep throat is a disease that causes a sore throat (pharyngitis). It is an infection with a germ called Group A Streptococcus bacteria.  Only a small portion of sore throats are the result of strep throat.

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It  is a contagious infection, spread through close contact with an infected individual.  this is not always needed as treatment may be decided based on symptoms. In highly likely or confirmed cases, antibiotics are useful to both prevent complications and speed recovery.

It’s important to identify strep throat for a number of reasons. If untreated, strep throat can sometimes cause complications such as kidney inflammation and rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a rash and even damage to heart valves.

Strep throat is most common between the ages of 5 and 15, but it affects people of all ages. If you or your child has signs or symptoms of strep throat, see your doctor for prompt treatment.

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Symptoms:
Symptoms may be mild or severe.One will often start to feel sick about 2 to 5 days after he or she  come in contact with the strep germ.

Fever may begin suddenly and is often highest on the second day. You may have chills.

You can have a red sore throat, sometimes with white patches. It may hurt to swallow. You may feel swollen, tender glands in your neck.

Other symptoms may include:
*General ill feeling, a loss of appetite and abnormal taste & Fever
*Headache
*Nausea
*Throat pain
*Difficulty swallowing
*Red and swollen tonsils, sometimes with white patches or streaks of pus
*Tiny red spots on the soft or hard palate — the area at the back of the roof of the mouth
*Swollen, tender lymph glands (nodes) in your neck
*Headache
*Rash
*Stomachache and sometimes vomiting, especially in younger children
*Fatigue

It’s possible for you or your child to have many of these signs and symptoms, but not have strep throat. The cause of these signs and symptoms could be a viral infection or some other kind of illness. That’s why your doctor generally tests specifically for strep throat.

It’s also possible to have the bacteria that can cause strep in your throat without having a sore throat. Some people are carriers of strep, which means they can pass the bacteria on to others, but the bacteria are not currently making them sick.

Some strains of strep throat can lead to a scarlet fever-like rash. The rash first appears on the neck and chest. Then it spreads over the body. It may feel like sandpaper.

Causes:
Strep throat is caused by group A beta-hemolytic streptococcus (GAS). Other bacteria such as non–group A beta-hemolytic streptococci and fusobacterium may also cause pharyngitis. It is spread by direct, close contact with an infected person and thus crowding as may be found in the military and schools increases the rate of transmission. It has been found that dried bacteria in dust are not infectious, although moist bacteria on toothbrushes or similar items can persist for up to fifteen days. Rarely, contaminated food can result in outbreaks. Of children with no signs or symptoms 12% carry GAS in their pharynx and after treatment approximately 15% remain carriers.

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Diagnosis:
The modified Centor criteria maybe used to determine the management of people with pharyngitis. Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.

One point is given for each of the criteria:

*Absence of a cough
*Swollen and tender cervical lymph nodes
*Temperature >38.0 °C (100.4 °F)
*Tonsillar exudate or swelling
*Age less than 15 (a point is subtracted if age >44)

The Infectious Disease Society of America however recommends against empirical treatment and considers antibiotics only appropriate following positive testing. Testing is not needed in children under three as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.

Laboratory testing:
A throat culture is the gold standard for the diagnosis of streptococcal pharyngitis with a sensitivity of 90–95%. A rapid strep test (also called rapid antigen detection testing or RADT) may also be used. While the rapid strep test is quicker, it has a lower sensitivity (70%) and statistically equal specificity (98%) as throat culture.

A positive throat culture or RADT in association with symptoms establishes a positive diagnosis in those in which the diagnosis is in doubt. In adults a negative RADT is sufficient to rule out the diagnosis however in children a throat culture is recommended to confirm the result. Asymptomatic individuals should not be routinely tested with a throat culture or RADT because a certain percentage of the population persistently “carries” the streptococcal bacteria in their throat without any harmful results.

Differential diagnosis:
As the symptoms of streptococcal pharyngitis overlap with other conditions it can be difficult to make the diagnosis clinically. Coughing, nasal discharge, diarrhea, and red, irritated eyes in addition to fever and sore throat are more indicative of a viral sore throat than of strep throat. The presence of marked lymph node enlargement along with sore throat, fever and tonsillar enlargement may also occur in infectious mononucleosis.

Possible Complications & Risk Factors:

*Acute rheumatic fever….click to see
*Scarlet fever
*Streptococcal toxic shock syndrome
*Glomerulonephritis
*Ear infection
*Glomerulonephritis
*Guttate psoriasis
*Mastoiditis
*Peritonsillar abscess
*Sinusitis

Treatment:
A number of medications are available to cure strep throat, relieve its symptoms and prevent its spread.

Antibiotics:
If you or your child has strep throat, your doctor will likely prescribe an oral antibiotic such as:
Penicillin. This drug may be given by injection in some cases — such as if you have a young child who is having a hard time swallowing or is vomiting.
Amoxicillin. This drug is in the same family as penicillin, but is often a preferred option for children because it tastes better and is available as a chewable tablet.

If you or your child is allergic to penicillin, your doctor likely may prescribe:
A cephalosporin such as cephalexin (Keflex)
Clarithromycin (Biaxin)
Azithromycin (Zithromax, Zmax)
Clindamycin

These antibiotics reduce the duration and severity of symptoms, as well as the risk of complications and the likelihood that infection will spread to classmates or family members.

Once treatment begins, you or your child should start feeling better in just a day or two. Call your doctor if you or your child doesn’t feel better after taking antibiotics for 48 hours.

If children taking antibiotic therapy feel well and don’t have a fever, they often can return to school or child care when they’re no longer contagious — usually 24 hours after beginning treatment. But be sure to finish the entire course of medicine. Stopping medication early may lead to recurrences and serious complications, such as rheumatic fever or kidney inflammation.

Untreated streptococcal pharyngitis usually resolves within a few days. Treatment with antibiotics shortens the duration of the acute illness by about 16 hours. The primary reason for treatment with antibiotics is to reduce the risk of complications such as rheumatic fever and retropharyngeal abscesses and they are effective if given within 9 days of the onset of symptoms

Analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) help significantly in the management of pain associated with strep throat. Viscous lidocaine may also be useful. While steroids may help with the pain they are not routinely recommended. Aspirin may be used in adults but is not recommended in children due to the risk of Reye’s syndrome.

Prognosis:
The symptoms of strep throat usually improve irrespective of treatment within three to five days. Treatment with antibiotics reduces the risk of complications and transmission; children may return to school 24 hours after antibiotics are administered. The risk of complications in adults is low. In children acute rheumatic fever is rare in most of the developed world. It is however the leading cause of acquired heart disease in India, sub-Saharan Africa and some parts of Australia.

Prevention:
Tonsillectomy may be a reasonable preventive measure in those with frequent throat infections (more than three a year). The benefits are however small and episodes typically lessen in time regardless of measures taken. Recurrent episodes of pharyngitis which test positive for GAS may also represent a person who is a chronic carrier of GAS who is getting recurrent viral infections. Treating people who have been exposed but who are without symptoms is not recommended. Treating people who are carriers of GAS is not recommended as the risk of spread and complications is low.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Streptococcal_pharyngitis
http://www.nlm.nih.gov/medlineplus/ency/article/000639.htm
http://ww.mayoclinic.com/health/strep-throat/DS00260

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Scarlet fever

Alternative Names : Scarlatina

Definition:
Scarlet fever is a disease caused by infection with the group A Streptococcus bacteria (the same bacteria that causes strep throat).Once a major cause of death, it is now effectively treated with antibiotics. The term scarlatina may be used interchangeably with scarlet fever, though it is commonly used to indicate the less acute form of scarlet fever that is often seen since the beginning of the twentieth century.
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It can affect people of any age. However, it’s most common between the ages of six and 12.

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Symptoms:

The time between becoming infected and having symptoms is short, generally 1 – 2 days. The illness typically begins with a fever and sore throat.

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The rash usually first appears on the neck and chest, then spreads over the body. It is described as “sandpapery” in feel. The texture of the rash is more important than the appearance in confirming the diagnosis. The rash can last for more than a week. As the rash fades, peeling (desquamation) may occur around the fingertips, toes, and groin area.

The common signs and symptoms that give scarlet fever are as follows:

*Red rash. The rash looks like a sunburn and feels like sandpaper. It typically begins on the face or neck and spreads to the trunk, arms and legs. If pressure is applied to the reddened skin, it will turn pale.

*Red lines. The folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the surrounding rash.

*Flushed face. The face may appear flushed with a pale ring around the mouth.

*Strawberry tongue. The tongue generally looks red and bumpy, and it’s often covered with a white coating early in the disease.

The rash and the redness in the face and tongue usually last about a week. After these signs and symptoms have subsided, the skin affected by the rash often peels. Other signs and symptoms associated with scarlet fever include:

*Fever of 101 F (38.3 C) or higher, often with chills

*Very sore and red throat, sometimes with white or yellowish patches

*Difficulty swallowing

*Enlarged glands in the neck (lymph nodes) that are tender to the touch

*Nausea or vomiting

*Headache

*Abdominal pain

*Bright red color in the creases of the underarm and groin (Pastia’s lines)

*Chills

*General discomfort (malaise)

*Muscle aches

*Sore throat

*Swollen, red tongue (strawberry tongue)

Causes:
Scarlet fever is caused by the same type of bacteria that cause strep throat. In scarlet fever, the bacteria release a toxin that produces the rash and red tongue.

The infection spreads from person to person via droplets expelled when an infected person coughs or sneezes. The incubation period — the time between exposure and illness — is usually two to four days.

Risk Factors:
Children 6 to 12 years of age are more likely than are other people to get scarlet fever. Scarlet fever germs spread more easily among people in close contact, such as family members or classmates.

Complications:
If scarlet fever goes untreated, the bacteria may spread to the:

*Tonsils
*Sinuses
*Skin
*Blood
*Middle ear

Rarely, scarlet fever can lead to rheumatic fever, a serious condition that can affect the:

*Heart
*Joints
*Nervous system
*Skin

Diagnosis:
Diagnosis of scarlet fever is clinical. The blood test shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (both indications of inflammation), and elevation of antistreptolysin O titer. Blood culture is rarely positive, but the streptococci can usually be demonstrated in throat culture. The complications of scarlet fever include septic complications due to spread of streptococcus in blood and immune-mediated complications due to an aberrant immune response. Septic complications—today rare—include ear and sinus infection, streptococcal pneumonia, empyema thoracis, meningitis and full-blown sepsis, upon which the condition may be called malignant scarlet fever.

Immune complications include acute glomerulonephritis, rheumatic fever and erythema nodosum. The secondary scarlatinous disease, or secondary malignant syndrome of scarlet fever, includes renewed fever, renewed angina, septic ear, nose, and throat complications and kidney infection or rheumatic fever and is seen around the eighteenth day of untreated scarlet fever.

The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps, and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks (on very dark skin, the streaks may appear darker than the rest of the skin). Areas of rash usually turn white (or paler brown, with dark complected skin) when pressed on. By the sixth day of the infection, the rash usually fades, but the affected skin may begin to peel. Usually there are other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever at or above 101 °F (38.3 °C), and swollen glands in the neck. Scarlet fever can also occur with a low fever. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. Also, an infected person may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever occurs because of a throat infection, the fever typically stops within 3 to 5 days, and the sore throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms started, and begins to peel (as above). The infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the person may not get a sore throat.

Treatment:
Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any strep throat. In case of penicillin allergy, clindamycin or erythromycin can be used with success. Patients should no longer be infectious after taking antibiotics for 24 hours. People who have been exposed to scarlet fever should be watched carefully for a full week for symptoms, especially if aged 3 to young adult. It is very important to be tested (throat culture) and if positive, seek treatment.

A drug-resistant strain of scarlet fever has emerged in Hong Kong, accounting for at least two deaths in that city – the first such in over a decade. The mutant strain of the bacterium is about 60% resistant to the antibiotics, says Professor Kwok-yung Yuen, head of Hong Kong University’s microbiology department. This is compared to a previous strain of the disease, which demonstrated a 10-30% resistance. This new strain may have spread to neighboring Macau and mainland China.

Prognosis:
With proper antibiotic treatment, the symptoms of scarlet fever should get better quickly. However, the rash can last for up to 2 – 3 weeks before it fully goes away.

Prevention :
Bacteria are spread by direct contact with infected people, or by droplets exhaled by an infected person. Avoid contact with infected people.

Children should be taught  to practice the following healthy habits:

*Wash  hands. Show your child how to wash his or her hands thoroughly with warm soapy water.

*Don’t share dining utensils or food. As a general rule, your child shouldn’t share drinking glasses or eating utensils with friends or classmates. And that rule applies to food, too.

*Cover your mouth and nose. Tell your child to cover his or her mouth and nose when coughing and sneezing to prevent the potential spread of germs.If your child has scarlet fever, wash his or her drinking glasses, utensils and, if possible, toys in hot soapy water or in a dishwasher.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/scarlet-fever/DS00917
http://en.wikipedia.org/wiki/Scarlet_fever
http://www.bbc.co.uk/health/physical_health/conditions/scarletfever1.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000974.htm
http://www.umm.edu/imagepages/19082.htm
http://www.healthofchildren.com/S/Scarlet-Fever.html
http://sigma.ontologyportal.org:4010/sigma/Browse.jsp?kb=SUMO&term=ScarletFever

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Throat Culture

Alternative Names:Throat culture and sensitivity; Culture – throat

Definition:
A throat infection with streptococcus bacteria (called strep throat) needs to be treated with an antibiotic.Throat swab culture is a laboratory test done to isolate and identify organisms that may cause infection in the throat. It is the traditional test used for identifying streptococcus bacteria on your throat surface. Throat cultures also can identify some other bacteria that can cause sore throat.

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Throat swab culture is a laboratory test done to isolate and identify organisms that may cause infection in the throat.The test is performed when a throat infection is suspected, particularly strep throat.

How do you prepare for the test?
No preparation is necessary.Only do not use antiseptic mouthwashes before the test.

What happens when the test is performed?
Tilt your head back with your mouth wide open.A sterile cotton swab is rubbed against the back of your throat to gather a sample of mucus from near the tonsils.Resist gagging and closing the mouth while the swab touches the back of the throat near the tonsils. This takes only a second or two and makes some people feel a brief gagging or choking sensation.

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In order to improve the chances of detecting bacteria, the swab may be used to scrape the back of the throat several times. The mucus sample is then placed on a culture plate that helps any bacteria present in the mucus grow, so they can be examined and identified.

How the Test Will Feel :
Your throat may be sore at the time the test is taken. You may experience a gagging sensation when the back of your throat is touched with the swab, but the test only lasts a few seconds.

What risks are there from the test?
There are no risks.This test is safe and well-tolerated. In very few patients, the sensation of gagging may lead to an urge to vomit or cough.

Normal Results:
The presence of the usual mouth and throat bacteria is a normal finding.

What Abnormal Results Mean :
An abnormal result means bacteria or other organism is present. This is usually a sign of infection.

Must you do anything special after the test is over?
Nothing.

How long is it before the result of the test is known?
Results from a strep culture are available in two or three days.

Resources:
https://www.health.harvard.edu/diagnostic-tests/throat-culture.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003746.htm

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Rapid Strep Test (RADT)

For a rapid strep test, the throat and tonsils are swabbed to collect bacteria from the infected area for testing. The bacteria are analyzed to see whether strep (streptococcal) bacteria are causing the sore throat.

.This scanning electron micrograph shows disease-causing Streptococcus bacteria, commonly found in the human mouth, throat, respiratory tract, bloodstream, and wounds. Often airborne in hospitals, schools, and other public places, Streptococcus bacteria are responsible for infections such as strep throat, scarlet fever, and some types of pneumonia.

A throat infection with streptococcus bacteria (called strep throat) needs to be treated with an antibiotic. A test is commonly used to find out whether streptococcus bacteria are present on your throat surface. The traditional test for a strep throat has been a throat culture, which takes two to three days to produce results. Several different types of rapid strep tests, however, can produce results within minutes to hours. A rapid strep test can only detect the presence of Group A strep, the one most likely to cause serious throat infections; it does not detect other kinds of strep or other bacteria.

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A good sample of throat secretions is needed to make sure the test is accurate. A person must remain very still during the procedure so that the doctor is able to collect enough secretions for an accurate test.

The Rapid Strep Test works by detecting the presence of a carbohydrate antigen unique to Group A Streptococcus. This may account for some of the problems with the Rapid Strep Test sensitivity. Gargling, eating or other infusion of liquids into the mouth prior to the test may affect the results. If the test is performed before sufficient organisms are present in the throat, or late in the infection when most of the strep germs have been cleared by the immune system, or if it is performed after someone has been partially treated with antibiotics that kill the organism, then the Rapid Strep Test is less likely to detect the organism.

If the Rapid Strep Test detects strep, the infection should be treated with appropriate antibiotics to prevent long-term damage and sequelae. Should the Rapid Strep Test fail to detect strep throat, the clinician might still treat the throat infection based on his or her own judgment.

How do you prepare for the test?
No preparation is necessary.

When it is required to do?

A rapid strep test may be done in the following cases:

*A person has symptoms of strep throat infection.

*A person has been exposed to strep during an epidemic of rheumatic fever.

The person has a personal or family history of rheumatic fever or other serious infections (such as toxic shock syndrome) and has been exposed to strep. In these cases, if there are no symptoms, a culture may be done first because it is more accurate than a rapid strep test.

In general, it is not necessary to test people who have been exposed to strep throat but do not have any symptoms.

What happens when the test is performed?
A cotton swab is rubbed against the back of your throat to gather a sample of mucus. This takes only a second or two and makes some people feel a brief gagging or choking sensation. The mucus sample is then tested for a protein that comes from the strep bacteria.


Risk factor.
:-
There are no risks.

Anything to be done after the test?
Nothing

How long is it before the result of the test is known?
Results may be available in minutes to a few hours. Often the doctor will ask you to wait in the office until the result is back.

Results:-
Findings of a rapid strep test may include the following:

Normal
A normal or negative test means that strep bacteria may not be present.

Sometimes, negative results are wrong. This means that you may have a negative rapid strep test result and still have strep throat.
A throat culture may be done if the rapid strep test result is negative.

Abnormal

An abnormal or positive strep test means that strep bacteria are present.

Antibiotic treatment can be started.
A positive test result does not distinguish those people with an active strep infection from those who are carriers of strep bacteria but actually have a viral infection (rather than a bacterial one).
What To Think About:
The rapid strep test costs less than a throat culture and may diagnose strep throat quickly

Resources:
https://www.health.harvard.edu/diagnostic-tests/rapid-strep-test.htm
http://www.webmd.com/a-to-z-guides/rapid-strep-test-for-strep-throat
http://en.wikipedia.org/wiki/RADT

http://encarta.msn.com/media_461520073_761574409_-1_1/streptococcus_bacteria.html

 

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Plague

Definition:
The typical sign of the most common form of human plague is a swollen and very tender lymph gland in the neck.This is known as a bubo – hence the alternative name for the disease of bubonic plague.
Plague is an infectious disease caused by a bacterium named Yersinia pestis.People usually become infected after being bitten by a flea which lives on rats and carries the bug.
Bubonic plague is 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 kills about 70% of patients in 4-7 days.

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Today plague is uncommon. This is largely due to better living conditions and antibiotics.

There are three forms of plague:

* Bubonic, which causes the tonsils, adenoids, spleen and thymus to become inflamed. Symptoms include fever, aches, chills and tender lymph glands
* Septicemic, in which bacteria multiply in the blood. It causes fever, chills, shock and bleeding under the skin or other organs
* Pneumonic, in which the bacteria enter the lungs and cause pneumonia. People with the infection can spread this form to others. This type could be a bioterror agent

Treatment for plague is a strong antibiotic. There is no vaccine for plague.

Plague was once deadly, but the disease is now curable provided it is caught in its early stages.

Pathology and transmission:
The Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea. The bacteria rapidly spreads to the lymph nodes and multiplies. Yersinia pestis can resist phagocytosis and even reproduce inside phagocytes and kill them. As the disease progresses, the lymph nodes can hemorrhage and become necrotic. Bubonic plague can progress to lethal septicemic plague in some cases.

Symptoms:
There are three types of plague: bubonic, septicemic and pneumonic. Signs and symptoms of plague vary depending on the type and on how you contract it. It’s possible to develop more than one type of plague.

Bubonic plague
This is the most common type of plague in humans, accounting for the majority of naturally occurring cases. Bubonic plague is caused by a bite from an infected flea and is characterized by an enlarged, infected lymph node called a bubo.

Signs and symptoms of bubonic plague generally appear within two to eight days after a plague-infected flea bites you. After you’re bitten, the bacteria travel through your lymphatic system, infecting the first lymph node they reach. The resulting bubo is usually 1 to 10 centimeters in diameter, swollen, painful and warm to the touch. It can cause so much pain that you can’t move the affected part of your body. The bubo usually develops in your groin, but may also appear in your armpit or neck, depending on where the flea bit you. More than one bubo can develop, but typically buboes affect only one area of your body.

Buboes may not be noticeable until a day or more after other symptoms appear. Other signs and symptoms of bubonic plague include:

* Sudden onset of fever and chills
* Headache
* Fatigue or malaise
* Muscle aches

Septicemic plague
Septicemic plague occurs when plague bacteria multiply in your bloodstream. You can contract this form of plague when bacteria transmitted by a fleabite enter directly into your bloodstream, or as a complication of bubonic or pneumonic plague. If septicemic plague occurs as a complication of bubonic plague, buboes may be present.

Signs and symptoms of septicemic plague include:

* Fever and chills
* Abdominal pain, diarrhea and vomiting
* Bleeding from your mouth, nose or rectum, or under your skin
* Shock
* Blackening and death of tissue (gangrene) in your extremities, most commonly your fingers, toes and nose

The gangrene associated with septicemic plague inspired the nickname Black Death for the 14th-century pandemic.

Pneumonic plague
Pneumonic plague is the least common form of plague — accounting for 12 percent of U.S. cases in the last 50 years — but the most rapidly fatal. Primary pneumonic plague can occur when you inhale infectious droplets coughed into the air by a person or animal with pneumonic plague. Early signs and symptoms, which generally occur about two days after inhaling contaminated droplets, include:

* High fever
* Weakness
* Signs of pneumonia, including chest pain, difficulty breathing and a cough with bloody sputum
* Nausea and vomiting

You can also develop pneumonic plague as a complication of bubonic or septicemic plague if the bacteria spread to your lungs. This is called secondary pneumonic plague.

Pneumonic plague progresses rapidly and may cause respiratory failure and shock within two days of infection. If antibiotic treatment isn’t initiated within a day after signs and symptoms first appear, the infection is likely to be fatal.

Plague resulting from a bioterrorist attack

It’s possible that plague bacteria could be turned into an aerosol and then might be spread over large populations as a bioterrorist weapon. An attack of this kind would cause pneumonic plague — the most deadly and most contagious type. In 1970, the World Health Organization estimated that if plague bacteria were sprayed over a city of 5 million people, up to 150,000 people could be infected and 36,000 might die.

According to a consensus statement by a group of scientists published in the Journal of the American Medical Association, the incubation period for pneumonic plague following a bioterrorist attack might last from one to six days, but more often from two to four days. Signs and symptoms would mirror those of naturally occurring pneumonic plague, but might also include nausea, vomiting, abdominal pain and diarrhea.

Other indications that a bioterrorist event or germ warfare is behind a pneumonic plague outbreak include a high incidence of pneumonic plague in humans in regions of the country that haven’t had outbreaks among animals or rodents, or when plague occurs in people without any known risk factors.

The most famous symptom of bubonic plague is swollen lymph nodes, called buboes. These are commonly found in the armpits, groin or neck. The bubonic plague was the first step of the ongoing plague. The two other forms of the plague, pneumonic and septicemic, resulted after a patient with the bubonic plague developed pneumonia or blood poisoning.

The plague causes fever and a painful swelling of the lymph glands called buboes, which is how it gets its name. The disease also causes symptoms like spots on the skin that are red at first and then turn black, heavy breathing, continuous blood vomiting, aching limbs and terrible pain. The person would not live 24 hours.

.Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness.Symptoms include high fever, chills, coughing up blood, and breathing difficulty.

Causes:
Plague has afflicted humans throughout history. The first recorded plague outbreak began in Egypt in A.D. 541.The Black Death pandemic in the 14th century killed one-third of Europe’s population. Europeans living during early pandemics believed the disease was a punishment from the gods or an unlucky confluence of astrological or supernatural elements.

The most recent plague pandemic began in China in the late 1800s and, due to booming international trade and ships with high rat populations, spread quickly throughout Asia and other parts of the world. That outbreak caused more than 12 million deaths in India and China alone.

The cause of plague, the Yersinia pestis bacterium, was discovered in 1894 by Alexandre Yersin. Soon after, scientists realized that fleas transmitted the bacteria.

In World War II, the Japanese army released plague-carrying fleas over a part of China, causing outbreaks of the disease. After World War II, both the United States and the former Soviet Union pursued biological weapons programs that developed means of exposing large populations to plague bacteria. Today, plague is one of a number of feared potential agents of bioterrorism, along with anthrax, smallpox, botulism, tularemia and nerve gases.

Diagnosis:
Your doctor may suspect plague if you live in a high-risk region. With the exception of a visible bubo, signs and symptoms often mimic other, more common infectious diseases.

You’ll likely be asked to describe the type and severity of your symptoms and tell your doctor about your recent history, including whether you’ve been exposed to sick animals or traveled to areas with plague outbreak.

If your doctor suspects plague, he or she may confirm the diagnosis through microscopic examination of fluid extracted from your bubo, bronchi or trachea. Needle aspiration is used to obtain fluid from your bubo. Fluid is extracted from your airways using endoscopy. In this procedure, a thin, flexible tube is inserted through your nose or mouth and down your throat. A suction device is sent down the tube to extract a fluid sample from your airways.

Your doctor may also test blood drawn from your veins to diagnose plague. Y. pestis bacteria generally are present in your bloodstream only if you have septicemic plague.

Treatment:
In the modern era, several classes of antibiotics are effective in treating bubonic plague. These include the aminoglycosides streptomycin and gentamicin, the tetracyclines tetracycline and doxycycline and the fluoroquinolone ciprofloxacin. Patients with plague in the modern era usually recover completely with prompt treatment, although the disease is rarely seen in the industrialized world.

However, there is concern about growing levels of resistance to the drugs.People suspected of having the plague should be hospitalised and medically isolated.
It is also important to test people who have been in close contact with sufferers.

Risk Factors:
The World Health Organization reports 1,000 to 3,000 cases of plague world-wide every year.It is found across south Asia, southern Africa and Central America.

Naturally occurring plague outbreaks are most common in rural areas and in urban areas characterized by overcrowding, poor sanitation and a high rat population. Outbreaks can happen at any time of year.

In the United States, plague outbreaks occur most often between April and November. Most U.S. cases occur in Western states, including New Mexico, Arizona, Colorado and California.

Rock squirrels and ground squirrels are the most common sources of infection in the United States. Other rodents, including chipmunks and prairie dogs, may host plague-carrying fleas. Animals that may be infected and pose a transmission risk to humans include wild rabbits and domestic cats that have contact with wild rodents.

The disease usually spreads through fleabites, but you can also contract plague after being exposed to an infected animal that may have coughed infectious droplets into the air or through a break in your skin after handling an animal with plague. Groups at increased risk include veterinarians, cat owners, hunters, campers and hikers in areas with recent plague outbreaks among animals.

Prevention:
Previously, a vaccine was available for bubonic plague, but its efficacy was never well studied and the manufacturer stopped producing it in 1999. Clinical trials on a new plague vaccine are in the earliest stages.

Although no effective vaccine is available, antibiotics offer effective preventive therapy if you’re at risk or have been exposed to plague. Ask your doctor immediately about preventive antibiotics if you:

* Have had close contact with a person or animal with known or suspected pneumonic plague
* Have been bitten by a flea or unknown insect in an area known to have recent plague cases
* Are planning to spend time in a region with recent plague outbreak

Take the following precautions if you live or spend time in regions where plague outbreaks occur:

* Avoid contact with sick or dead animals. If you hunt, wear gloves when handling dead animals.
* Rodent-proof your home. Remove potential nesting areas, such as piles of brush, rock, firewood and junk. Don’t leave pet food or any other foods in areas that rodents can easily access.
* Prevent your pets from contracting fleas. Use flea-control products and don’t allow pets to wander unsupervised. Ask your veterinarian for recommended flea-control brands and guidelines.
* Take precautions when outdoors. Closely supervise your children and pets when spending time outside in areas with large rodent populations. Use insect repellent on your skin and clothing.

Know the risk factors and the symptoms of plague so that you can identify it early and contact your doctor immediately. If you know of recent plague cases in your area, report sick or dead animals to your local health department or to police.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Resources:
http://news.bbc.co.uk/2/hi/health/medical_notes/n-p/1834332.stm
http://en.wikipedia.org/wiki/Bubonic_plague
http://www.mayoclinic.com/print/plague/DS00493/DSECTION=all&METHOD=print