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Tourism Health Threat

Peru plague outbreak

Aug 03, 2010

Peru Health Minister Oscar Ugarte says authorities are screening sugar and fish meal exports from the Ascope province, located about 325 miles (520 kms) northwest of Lima. Popular Chicama beach isn't far away.

An outbreak of plague has killed a 14-year-old boy and infected at least 31 people in a northern coastal province.

Ugarte says the boy, who had Down syndrome, died of bubonic plague July 26.
He said Monday that most of the infections are bubonic plague, with four cases of pneumonic plague. The former is transmitted by flea bites, the latter by airborne contagion. The disease is curable if treated early with antibiotics.

Bubonic plague is the best known manifestation of the plague, caused by the Gram-negative bacterium Yersinia pestis (formerly known as Pasteurella pestis). It belongs to the family Enterobacteriaceae. The term bubonic plague is derived from the Greek word bubo, meaning "swollen gland." Swollen lymph nodes (buboes) especially occur in the armpit and groin in persons suffering from bubonic plague. Bubonic plague was 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. The bubonic plague kills about two out of three of infected patients in 2–6 days without treatment. It may have been the cause of the Black Death that swept through Europe in the 14th century and killed more than 25 million people, one third of the European population.

The most famous symptom of bubonic plague is painful, swollen lymph glands, called buboes. These are commonly found in the armpits, groin or neck. Due to its bite-based form of infection, the bubonic plague is often the first step of a progressive series of illness. Two other forms of the plague, pneumonic and septicemic, often resulted after a patient with the bubonic plague developed pneumonia or blood poisoning. However, pneumonic plague, unlike the bubonic or septicemic, induced coughing, was also very infectious and allowed person-to-person spread.

Other symptoms include heavy breathing, continuous blood vomiting, urination of blood, aching limbs, coughing, and extreme pain. The pain is usually caused by the decaying or decomposing of the skin while the person is still alive. Additional symptoms include fever, headaches, chills, extreme tiredness, gastrointestinal problems, lenticulae (black dots scattered throughout the body), delirium, coma, and death.

The bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, Xenopsylla cheopis (the rat flea). The fleas are often found on rodents, such as rats and mice, and seek out other prey when their rodent hosts die. The bacteria form aggregates in the gut of infected fleas and this results in the flea regurgitating ingested blood, which is now infected, into the bite site of a rodent or human host. Once established, bacteria rapidly spread to the lymph nodes and multiply. Y. pestis bacilli can resist phagocytosis and even reproduce inside phagocytes and kill them. As the disease progresses, the lymph nodes can hemorrhage and become swollen and necrotic. Bubonic plague can progress to lethal septicemic plague in some cases. The plague is also known to spread to the lungs and become the disease known as the pneumonic plague. This form of the disease is highly infectious as the bacteria can be transmitted in droplets emitted when coughing or sneezing, as well as physical contact with victims of the plague or flea-bearing rodents that carry the plague.

In modern times, several classes of antibiotics are effective in treating bubonic plague. These include the aminoglycosides streptomycin and gentamicin, the tetracyclines and doxycycline, and the fluoroquinolone ciprofloxacin. Mortality associated with treated cases of bubonic plague are about 1-15 percent, compared to a mortality rate of 40-60 percent in untreated cases.

The first recorded plague outbreak in Peru was in 1903. The last, in 1994, killed 35 people.

Peru plague outbreak

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