BUBONIC

PLAGUE

Black Death / Blue Sickness / La Pest / The

Great Mortality
BUBONIC PLAGUE
Definition
• The term bubonic is derived from the Greek word boubon,
meaning "groin

• The term "buboes" is also used to refer to the swollen lymph

nodes

• The plague is believed to be the cause of the 

Black Death that 
swept through Asia, Europe, and Africa in the 14th century an
d killed an estimated 50 million people.
[

BUBONIC PLAGUE
Epidemiology
• Endemic in countries of Africa, Asia, the Americas and
the former Soviet Union.
• There have been 3 recorded pandemics throughout
history. Most notably the 'Black Death' which originated
in Central Asia in 1346 which is estimated to have caused
25 million deaths worldwide.
• In 2003 2,118 cases and 182 deaths were reported
worldwide, over 98% of which were reported in Africa.
• The last reported outbreak of plague in the UK was in
1918.

BUBONIC PLAGUE
There are three basic forms of plague:
• Bubonic plague-The most common form of plague is
bubonic plague.
• Septicemic plague. When the bacteria enter the
bloodstream directly and multiply there, it's known as
septicemic plague.
• Pneumonic plague- or lung-based plague, is the most
virulent form of plague. Any person with pneumonic
plague may transmit the disease via droplets to other
humans.

BUBONIC PLAGUE
Causative agent
> Yersinia pestis
• - is a Gram-negative, nonmotile, rod-shaped
coccobacillus, with no spores
• -It is a facultative anaerobic organism that can infect
humans via the oriental rat flea.
• - It causes the disease plague, which takes three main
forms: pneumonic, septicemic, and bubonic plagues.

BUBONIC PLAGUE
BUBONIC PLAGUE
Yersinia pestis
• Reservoir
Wild rodents (especially ground squirrels). Domestic pets
may carry infected fleas.
• Rodents are mouse, rats, squirrels, hamsters, guinea pigs
• Domestic pets are dogs, cats, horses, sheeps, rabbits,
birds like parrots.

BUBONIC PLAGUE
BUBONIC PLAGUE
BUBONIC PLAGUE
Acral necrosis of the nose, the lips, and the
fingers and residual ecchymoses over both
forearms in a person recovering from bubonic
plague that disseminated to the blood and the
lungs. At one time, the person's entire body
was ecchymotic.
Mode of transmission

• Commonly through the bite of an infective flea. Other

important modes of transmission include direct contact
with infectious body fluids, handling of tissues of
infected animals and inhalation of infectious respiratory
droplets.  
• Primary pneumonic plague is transmitted thorough
inhalation of aerosolized infective droplets and can be
spread from person to person.

BUBONIC PLAGUE
Incubation Period

•  A person usually becomes ill with bubonic plague 2 to 6

days after being infected. Someone exposed to Yersinia
pestis through the air would become ill within 1 to 3
days.

BUBONIC PLAGUE
Period of communicability
• Fleas may remain infective for months.

Pathognomic Sign
• Characterized by painful swollen lymph nodes or
'buboes'.

BUBONIC PLAGUE
BUBONIC PLAGUE
Clinical Manifestations
• Bubonic plague causes fever, fatigue, shivering,
vomiting, headaches, giddiness, intolerance to light, pain
in the back and limbs, sleeplessness, apathy, and
delirium. It also causes buboes: one or more of the lymph
nodes become tender and swollen, usually in the groin or
armpits.

BUBONIC PLAGUE
Diagnostic Exams
• Bacteriology (Gold Standard)
• Yersinia pestis culture (a sample is taken from a patient;
this confirms the presence of the plague)
• Rapid Dipstick testing RDT (confirms presence of
Yersinia pestis antigen in patients)
• Serum Examination (this verifies presence of infection)

BUBONIC PLAGUE
Complications
•  Disseminated Intravascular Coagulation (DIC)
• Pneumonia 
• Meningitis
• Death (endotoxic shock)

BUBONIC PLAGUE
Treatment
1. Aminoglycosides: streptomycin and gentamicin IM
• Streptomycin- drug of choice, 30 mg/kg/day, full course of 10 days of
therapy or until 3 days after the temperature has returned to normal.
• Gentamicin has been found to be effective in animal studies, and is
used to treat human plague patients
2.Chloramphenicol - is a suitable alternative to aminoglycosides in
the treatment of bubonic
• Dosage should be 50 mg/kg/day administered in divided doses either
parenterally or, if tolerated, orally for 10 days. Chloramphenicol may
be used adjunctively with aminoglycosides.
3. Tetracyclines- An oral loading dose of 15 mg/kg tetracycline (not to
exceed 1 g total) should befollowed by 25-50 mg/kg/day (up to a total
of 2 g/day) for 10 days.Tetracyclines may also be used adjunctively with
other antibiotics.
BUBONIC PLAGUE
• 4. Sulfonamides - is given as a loading dose of 2-4 g
followed by a dose of 1 g every 4-6 hours for a period of 10
days. In children, the oral loading dose is 75 mg/kg,
followed by 150 mg/kg/day orally in six divided doses. The
combination drug trimethoprim-sulfamethoxazole has been
used both in treatment and prevention of plague
• 5. Fluoroquinolones - such as ciprofloxacin, have been
shown to have good effect against Y. pestis in both in vitro
and animal studies . Ciprofloxacin is bacteriocidal and has
broad spectrum activity against most Gram-negative
aerobic bacteria, including Enterobacteriaceae and
Pseudomonas aeruginosa, as well as against many Gram-
positive bacteria.

BUBONIC PLAGUE
Common Nursing Diagnosis
• Risk for Infection related to damage skin integrity
• Altered skin integrity
• Knowledge Deficit
• Disturbed sleep pattern
• Alteration in comfort

BUBONIC PLAGUE
Nursing Management
• Antibiotic therapy is the management of choice to treat
bubonic plague.
• Respiratory support may be necessary on the course of
treatment coupled with intravenous support. 

BUBONIC PLAGUE
THE END

Thank You For Listening.