There plague has not disappeared. A rare human case bubonic plague was identified in the United States in February 2024.”There have been no indigenous cases of bubonic plague since 1945 in France metropolitan and overseas immediately reassures Professor Guillaume Desoubeaux, Head of Parasitology – Mycology – Tropical Medicine Clinic at Tours University Hospital. “The main focus of the plague is Madagascar, with 250 to 500 cases per year for a global total per year of 600 to 700 cases. The other main epidemic foci are the Democratic Republic of Congo and Peru“, he indicates. Before recalling that “the“Plague epidemics can die out for decades and then flare up again.”
What is the plague?
“Plague is an infectious disease caused by the bacterium Yersinia pestis which can cause an illness that can range from a localized form to a systemic (generalized) form. There is several stages of the disease depending on its progress. explains Professor Desoubeaux. We distinguish the initial, localized phase, which is bubonic plague, from the terminal phase where the plague is called “systemic” (septicemia) with a marked pulmonary form. If left untreated, bubonic plague is fatal in 30 to 60% of cases and systemic plague in almost 100% of cases.
“The plague is a disease that is transmitted first by the bite of fleas which are mainly found on rats. There can be human-to-human transmission, with contact with pus from the buboes, but this remains very rare. When the plague is widespread, transmission is human-to-human. Saliva droplets can transmit the bacteria to another person” specifies the specialist.
What are the symptoms ?
“The incubation phase is 1 to 7 days for the most common bubonic plague and it is silent. Non-specific clinical signs then appear: flu syndrome with fever, headache and body aches. Then will appear one or more buboes who are painful, swollen, red lymph nodes, which can suppurate. When the flea carrying the germ has bitten the leg, the bubo is generally located in the inguinal fold. When the disease becomes widespread, it results in very virulent pulmonary symptoms : cough, sputum with blood present. The patients are prostrate or agitated, they are delirious, have attacks of convulsions, confusion“, explains our interlocutor.
Is there a vaccine?
“There was a vaccine that was abandoned because it had too many side effects. A new vaccine is being evaluated in humans but it is not effective against pneumonic plague, informs Professor Desoubeaux. Prophylactic (preventative) antibiotic treatment may be administered for 7 days or more to healthcare workers who are in contact with potentially ill people..”
What are the treatments ?
The bubonic plague treated with antibiotics. “Are used aminoglycosides, cyclins, quinolones. In case of systemic plague, antibiotic treatment must be administered very quickly in which case the risk of mortality is very high. specifies Professor Desoubeaux. People with pneumonic plague should be placed in isolation with precautionary measures for healthcare workers because it is easily transmitted through the respiratory route.“.
Thanks to Professor Guillaume Desoubeaux, Head of Parasitology – Mycology – Tropical Medicine Clinic at Tours University Hospital.