PLAGUE
INTRODUCTION-
Plague is a primarily and basically a zoonoses,caused by Yersinia pestis,involving rodents and fleas.Plague occurs in many forms- enzootically, epizootically, sporadically and in epidemics of all types including anthroponotic and primary pneumonic forms.
PROBLEM STATEMENT-
Occurance of Plague before 20th century is more than the 1st decade of 20th century. In 1950,there is 40,484 cases,and in between 1980-1984 there is 3037 cases.Over the last ten years,the mean annual global Plague case fatality rate has been 7%,ranging from just over 14% in Africa to just under 4% in the America.
The annual mortality was over 500,000 deaths between 1898 & 1908.-----------> major public health problem in mid 1940`s.------------>large scale DDT application -----------> Plague free India
The last PHA-positive sera specimen from rodents were observed in 1976 in district Beed Maharashtra abd in 1979 in area of Kolar.
Recent cases are reported a total 16 cases (with 4 deaths) of pneumonic Plague in 19th Feb.2002 in Shimla,Himachal Pradesh and confirmed by NICD.
DEFINITION-
An often fatal disease caused by yersinia pestis;the vector is the rat flea & disease is characterised by high fever,restlessness,confusion,prostration,delirium,shock and coma.
ETIO-PATHOLOGY-
CAUSE=
caused by Yersinia pestis.
PATHOLOGY=
*Yersinia pestis ------------> Skin -------> lymph nodes ---------> elicit inflammatory response ----------> haemorrhage ---------> septicaemia ensues & necrotic changes --------> oliguria & shock ----------> Plague
*inhalation of y.pestis causes alveolitis.
CLINICAL FEATURES-
*HIGH grade fever,
*Restlessness,
*Confusion,
*Prostration,
*Delirium,
*Shock,
*Coma,
*Dry skin,
*Rigor,
*Severe headache,
*Aching & swelling of lymph nodes,
*Rapid pulse,
*Hypotension,
*Cough & dyspnoea,
*G.I.T. c/o like nausea,vomoting,abdominal pain & diarrhoea.
PROPER EPIDEMIOLOGY-
(1)AGENT FACTORS:
Agent of Plague is Y.pestis,is a gram negative bacteria, non-motile,cocco-bacillus that exhibits bipolar occur in great abundance in the buboes,blood ,spllen,liver & other viscera of infected persons.
RESERVOIR OF INFECTION:
Wild rodents are the natural reservoir of Plague.
In India,Tatera indica has been incriminated as the main reservoir.
SOURCE:
Infected rodents and fleas and case of pnumonic Plague.
(2)HOST FACTORS:
Age & Sex:
all ages and sexs are susceptible.
Human activities:
Man in contact with y.pestis infection.
Immunity:
Man has no immunity.
(3)ENVIORNMENTAL FACTORS:
Season:
In northern India,the Plague season starts from september untill may.
Temperature & humidity:
A mean temp. of 20`C to 25`C and a relative humidity of 60%,a favourable condition to spread Plague.
DIAGNOSIS-
The typical sign of the most common form of human Plague is a swollen and very tender lymph nodes,accompanied by pain.The swollen gland is called as "bubo".
Bubonic Plague should be suspected when a person develops a swollen gland,fever,chills,headache and extreme exhaustion and has a h/o of possible exposure to infect rodents or fleas.A person usually becomes ill with bubonic Plague 2 to 6 days after being infected.
Specimen should be obtained from appropriate sites for isolating the bacteria.
(a)Blood smear test = Organism may be seen in blood smears of the patient is septicemic,while blood smears taken from suspected person & negative for bacteria.
(b)Fluorscent Antibody test (FA test)= sputum/throat smear taken & it is diagnostic value if only Wayson stain is used.
(c)Bio-chemical analysis = Plague bacilli are relatively inactive by standard enteric bio-chemical reactions.
(d)Polymerase Chain Reaction test (PCR test) = done to determine Plague bacilli.
MANAGEMENT-
If the diagnosis is suspected on clinical and epidemiological ground,treatment must be started as soon as,or even before,samples have been collected for lab. diagnosis.Treatment may also be needed for acute circulatory failure,DIC & hypoxia.
GENUS EPIDEMICUS-
Epidemics of Plague is mentioned in "BIBLE" & "BHAGWAT PURAN". Plague is a epidemic as well as a pandemic disease.
HOMOEOPATHIC PROPHYLAXIS-
Plague could not treated as a specific disease but it could be treated as group of symptoms.
HOMOEOPATHIC THERAPEUTICS-
CALADIUM
*Inflamed mucous membrane of mouth and fauces.
*Profuse Saliva with choking sensation and a desire to swallow with difficulty.
BUFO R.
*It casuse low grade inflammatory action,fetid exhalation and discharge.
*Dirty greenish oily skin.
*Raw surface of skin with ichorous fluid-burning blisters,
*Sweat profuse and oily skin
ANTHRACINUM
*Haemorrages:blood oozes from mouth,nose,anus or several organs,bllod is thick,tar like.
*Septic fever & inflammation.
*Rapid loss of strength.
*Sinking pulse,
*Delirium & FAINTING,
*Gangrenous ulcer,
*Marked prostration.
BAPTISIA
*Great langour,
*Wants to lie down,
*Generalties:tired,bruised,sick feeling.
HIPPOZEANIUM
*Hoarseness,
*Dyspnoea,
*Cough & Obstructed respiration.
CONCLUSION-
Plague is a epidemic as well as an pandemic disease.Plague is now not exist in community after 1994. House rats are not reponsible for causing Plague.But we can treat it our homoeopathic medicine. Homoeopathic medicines are used for cure as well as prophylactic.
REFERENCE-
(1)Park`s textbook of Preventive and Social Medicine by K.Park.
(2)Davidson`s Principles & Practice of Medicine;20th ed.
(3)Taber`s Cyclopedic Medical Dictionary by JayPee.
(4)Practical Homoeopathic Therapeutics by Dewey.
(5)Pocket Mannual of Homoeopathic Materia medica & Repertory ;William Boericke,M.D.
(6)Allen`s Keynote;H.C.Allen,
(7)Hering`s Materia Medica by C.Hering,
Dr.Abhishek Pandey
kanpur
