Avoid like the plague
Is it normal to get alarmed when the word plague is heard?
I have always associated this word with the story of the Pied Piper long before I knew the extent to which rodents can cause several diseases. For those unfamiliar with the folktale, in the first half, the lead character was responsible for averting a possible epidemic by luring all the rats in his town through his music, leading them to drown in the river. Reflecting on how it ended, I can only wish for the moon for two things: one, for vector control to be that simple, and two, for the moral behind the story to sink in. The latter should serve as an invite for anyone to refresh their memory, or better yet, include it as a bedtime story for their children.
In the past week, it has been brought into the spotlight and sparked a review of a disease that we haven’t encountered and, admittedly, have read little about, largely due to a recently reported death of a laboratory worker in Russia. History revealed that there have been three major plague pandemics on record, the last of which occurred in the 19th century and had spread from China. For the Philippines, in the same period, according to an article published in the Journal of the American Medical Association and written by Goff, there were 55 cases recorded from June 1912 to March 1913. The author wrote, “it is presumed that an infected rat came ashore from some boat from the mainland.” Currently, it is endemic in areas where there are wild rodent populations.
Humans are incidental hosts and acquire the bacteria through different routes: from bites by infected rodent fleas, inhalation of droplets from infected humans or respiratory secretions from infected animals, handling of infected animal tissues, consumption of contaminated food, and laboratory exposure. The ability to be transmitted via aerosolized droplets makes it a potential biologic weapon.
The incubation period is usually from two to six days, and of the three major syndromes, the most common is what we know as the bubonic plague. Patients present with fever, chills, headache, weakness, and swelling and pain in the lymph nodes, particularly those that drain from the bite and are termed “buboes.” From buboes, infection may spread via the bloodstream in the absence of treatment, causing sepsis, pneumonia, or meningitis.
Pneumonic plague occurs rarely and is classified into two forms: primary, which is caused by inhalation of droplets or lab exposure, and secondary, resulting from disseminated spread. Affected individuals present with fever, chills, acute onset of dyspnea, cough accompanied by bloody sputum, and pleuritic chest pain. It can be rapidly fatal without immediate treatment. From available data, mortality is estimated to be between 60 and 100 percent for untreated cases, and less than 15 percent for those who received treatment.
Diagnosis lies in a high index of suspicion based on travel from an endemic area or contact with possibly infected rodents together with clinical manifestations as previously described, such as fever, painful lymphadenitis, and pneumonia associated with hemoptysis. It is worthy of note that in the absence of buboes, diagnosis may be delayed or missed.
Confirmatory tests include serology, blood culture, Gram staining, and polymerase chain reaction. A rapid diagnostic test is in development together with potential vaccines.
Antimicrobial agents used to treat Yersinia pestis, which is the etiologic agent, include aminoglycosides, fluoroquinolones, and tetracyclines. Prophylaxis is recommended for exposed individuals with unprotected face-to-face contact with known or suspected cases and who have not received at least 48 hours of effective drug therapy. In healthcare settings and for those caring for patients, droplet and standard precautions should be observed. For travelers going to endemic areas, avoidance of exposure is still the best method of prevention.
The World Health Organization has classified it as a low global risk, and the European Centre for Disease Prevention and Control is closely monitoring events.
This incident is just an example of how possibilities can turn into potential threats. While it may generate all sorts of conspiracy theories, let us not get lost in it. In our midst still exist vaccine-preventable diseases, such as measles, pulmonary and disseminated tuberculosis, drug resistance against first-line agents, leptospirosis, dengue, HIV, aside from other neglected tropical diseases. These are major causes of alarm, as they can cause both significant morbidity and mortality. Let us address and arrest these first if we are serious as a country about making health a top priority. I know that we have enough capable people in positions who genuinely work toward making things right or better for us, and even many more willing to battle and overcome the challenges tied to a severely diseased system. This piece of information should at least keep that flame of hope alive within each and every one of us.
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