Veterinary Medicine-UB

PLAQUE
Pest, black death, pestilential
fever

Etiologic agent
The

etiologic agent is Yersinia pestis

The cause of the Justinian Plague in the 6th century
"The Black Death" in the Middle Ages, during which
one-fourth of Europe's population died.
Another pandemic: killed over 12 million people
around the world from 1896-1930.
Plague continues to be a disease of importance in
some regions of the world today, especially parts of
Asia, Africa and South America (Peru, Ecuador,
Bolivia, Brazil).
WHO: In the 1980's, there were more than 8,000
cases of human plague reported
Natural infection: in a range of mammalian species
including rodents, cats, other carnivores, and humans

Gram (-), facultative anaerobe, bipolar rod

staining (coccobacillus)
Catalase +
Oxidase
Microaerophilic
Yersinia:
Y. pestis
plaque
Y. pseudotuberculosis & Y. enterocolitica

human diarrheal
F. tularensis
human septic infection
Pasteurella
animal & human pathogens

Modes of transmission of
Yersinia pestis

Transmission via fleas:

The primary reservoir for Y. pestis is
rodents. Transmission among rodents and
other wild animals, humans and domestic
animals (accidental hosts in terms of the
life cycle of the organism) occurs via the
bite of an infected flea

Rodent infected with Y. pestis

Flea

Y. pestis multiply in the gut of flea

Coagulase
Block proventriculus, so no food can pass through
The hungry flea bites ferociously
Aspirated blood was contaminated Y. pestis
Regurgitated in the bite wound
Phospolipase enzyme & antiphagocytic protein
Resistant to killing phagocytosis mechanism

multiply

Lymphatic
Inflammation (enlarge the lymph nodes)
Necrosis

fulminant

Bloodstream (dissemanation)
Hemorrhagic & necrotic in all organs
Pneumonic plaque with hemorrhagic, sepsis, & dead

Transmission by ingestion of an
infected animals:
Ingestion of infected rodents is a
common method of transmission to
domestic cats, and can also be a route of
infection for humans

 Transmission

through contact with body fluids

from infected animals:
Humans can contract Y. pestis directly through
contact with blood, pus or aerosols from infected
animals.
For this reason, veterinarians and wildlife personnel are

at risk for zoonotic transmission.

Cats are the domestic animal of most concern for
zoonotic spread to veterinarians.
Since 1977, 23 human cases of plague (including 5
fatal cases) have been linked to direct exposure to Y.
pestis-infected cats. Six of the cases were in DVMs or
their staff.

Clinical presentation of
Yersinia pestis infection in
humans, cats and dogs
Three major forms of disease occur in both cats and
humans.
Bubonic plague:
This usually produces an ulcer at the site of the bite
and enlarged painful lymph nodes ("buboes")
Following a 2-8 day incubation period, patients
develop high fever (105 F+), anorexia, lethargy,
headache, malaise, and warm, swollen, extremely
painful lymph nodes that undergo hemorrhagic
necrosis.
75% of cases in cats involve the submandibular LNs,

consistent with ingestion as a route of entry.

In humans, buboes occur most commonly in the groin.
Meningitis

can occur as a sequela in humans

Septicemic plague:
This

occurs when the organism spreads hematogenously

to virtually every organ in the body. Yersinia pestis can
survive and replicate within mononuclear leukocytes. The
bacteria replicating in these cells acquire capsules that
inhibit phagocytosis and killing by PMNs.
Orth et al., 2000: suggest that Y. pestis organisms release
a cysteine protease-like compound [YopJ] into
macrophages that blocks signal transduction and the
ability of the macrophage to synthesize tumor necrosis
factor. As such, macrophages are unable to recruit help
from B and T cells to eliminate the organisms.)
Pre-existing buboes may or may not be present in cases of

septicemic plague.
Shock,

and death can occur within 2 days of systemic

spread.

Pneumonic plague:
Infection in the lungs may follow inhalation of the
organism or systemic spread.
This is considered the most fatal form of plague. It is
100% fatal in people if left untreated. This is the route
of concern for the use of Y. pestis as a bioterrorist
agent (CDC List A).
A retrospective review of 119 clinical cases of plague in cats

revealed that 53% of the cases presented as bubonic, 37%

were septicemic and 10% were pneumonic. The overall case
fatality rate in cats was 33%.
In

dogs, Y. pestis infection is generally much less

severe, often being subclinical or causing only mild
fever and lymphadenopathy (and possibly cough).

Diagnosis:
Specimens

: blood, aspirates of enlarged lymph

nodes
sputum, CSF
Smear
Giemsas stain
bacterial culture : BAP, MacConkey, BHI
gram (-) bipolar rod---It is very important that

the organism not be mistakenly identified as a

diplococcus!
Wayson or Wright's stains accentuate the bipolar
appearance of the organism.
immunofluorescent antibody staining to confirm the
identity of the bacteria as Y. pestis

serology

is used less commonly

Treatment:
Aspirate

buboes if they suppurate.

antibiotics (suggested cours of 10-21 days)
Doc: streptomycin
Gentamicin or other aminoglycosides are the antibiotics of

choice. (Streptomycin is commonly used in human beings.)

Yersinia pestis is often sensitive to penicillin and ampicillin in vitro,
but is generally resistant to these antibiotics in vivo.

Doxycycline and chloramphenicol may also be useful, and

fluoroquinolones are used in cases of meningitis in human

beings.
From

a public health perspective, flea control is very

important to prevent further spread of the organism.

Prevention of Yersinia pestis

transmission to veterinarians
All

patients with suspected plaque should be

isolated
Destruction of plaque-infected animals
All specimens must be treated with extreme caution
WHEN DRAINING ABSCESSES, ALWAYS WEAR
GLOVES AND A MASK FOR PROTECTION!
Contact of patients with suspected plaque
pneumonia should receive chemoprophylaxis:
tetracycline 0,5 g/d for 5 days
A formalin-inactivated vaccine is available for persons
traveling to endemic areas, or for those who work in regular
contact with rodents
A new vaccine specifically designed to be able to prevent
pneumonic plague is being developed by the U.S. Army
because of the risk of plague as a biological weapon.

Vaccination against Yersinia

pestis infection
Human beings:
A formalin-inactivated vaccine is available for
persons traveling to endemic areas, or for those
who work in regular contact with rodents. To
date, however, this vaccine has not been
routinely recommended for veterinarians.
A live attenuated vaccine specifically designed
to prevent pneumonic plague is also available,
but retains some virulence, and is, thus, not
widely used. Alternative attenuated strains and
subunit vaccines are being developed because of
the risk of plague as a biological weapon.

Animals:
A plague vaccine for cats is currently being developed
commercially in the U.S.
There is also interest in developing a vaccine for
endangered black-footed ferrets and prairie dogs. Both
are quite sensitive to Y. pestis infection. In addition,
plague among prairie dogs is a significant impediment to
successful re-introductions of the ferrets. This is because
the prairie dogs serve as not only a major prey food
source for the ferrets, but they also share their tunnel
homes with the ferrets. During the summer of 2000, tens
of thousands of prairie dogs died of plague in the western
U.S., and another outbreak occurred in Colorado in 2002.

TERIMA KASIH