Plague kills 40 in Madagascar

A plague outbreak in Madagascar has killed 40 people, the World Health Organization said, warning that the disease could spread rapidly in the country. The first victim was identified on August 31 in the area west of the capital. The person infected there died three days later.

By mid-November, 119 cases of plague had been confirmed, two percent of which were due to the pulmonary strain – one of the most dangerous infectious diseases with very high death rate.

Plague mainly affects rats and is spread by fleas, but humans can contract the disease if they are bitten by an infected flea. The situation in Madagascar is even more alarming because the country’s fleas have a high degree of resistance to insecticides, the World Health Organization has warned.

Plague is an infectious disease usually caused by the bacterium Yersinia pestis. It is transmitted in three main ways.

One is respiratory, in which the plague bacterium enters the lungs after inhalation. It is spread through the air by the coughs of those infected with the plague and, less commonly, by dust. Plague is also transmitted through the food route, when the bacteria enter the mouth with contaminated water or food.

The infection is transmitted to food after it has been touched by sick people, or it has been stepped on or gnawed by infected rodents. Water becomes infected if faecal water contaminated with the bacteria gets into it, or if infected rodents have been swimming in it. The direct way of transmission of the infection is from the bite of infected insects, usually fleas.

When they suck blood from a plague patient, they also pick up the bacteria. They multiply in the insect’s chitinous foregut, clog it, and the flea becomes hungry again, trying to suck more blood. Because her stomach is blocked, she vomits the blood, along with the plague bacteria, back into the wound. Rat fleas are the most at risk for the transmission of plague.

The disease occurs in several forms. One is cutaneous, forming a pimple after a flea bite. It may disappear naturally, but in 99 percent of cases the infection develops into the so-called bubonic form of the plague when the bacteria reaches the lymph nodes. There it multiplies, the nodes become inflamed and swollen, and if the disease is not treated, it causes death in 90 percent of cases.

The plague can also have an intestinal form if the infection is through food. The bacterium penetrates the intestinal walls and multiplies inside them. With this form of the disease, mortality is total, and history has not described a case of survivors without treatment.

Pneumonic plague develops after inhalation, or secondarily when the infection is in the neighboring lymph nodes. The bacterium multiplies in the lung alveoli and destroys them.

The lung infection itself develops very quickly – up to two hours after infection. Sometimes it starts with a pulmonary hemorrhage when the bacteria has cut the wall of a blood vessel in the lung. In some cases, this hemorrhage can lead to death.

If left untreated, plague kills within minutes to a few hours after the first symptoms. Treatment with combined powerful and fast-acting antibiotics is necessary.

The plague can also have a septic form – in intestinal and bubonic plague bacteria enter the blood and through it spread throughout the body. Even with treatment, the prognosis is hopeless and the sick die.
Since the Middle Ages, there have been three plague epidemics in which 200 million people died. In the 14th century, a third of the population in Europe died from the plague.

Although it is believed that there is a cure for the plague and modern lifestyles rule it out, many people die every year in the poorer countries of the world. Unfortunately, there are antibiotics that plague strains are resistant to.

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