Plague Inc Apk
Avery Blaschko
Plague is a very severe disease in people, particularly in its septicaemic (systemic infection caused by circulating bacteria in bloodstream) and pneumonic forms, with a case-fatality ratio of 30% to 100% if left untreated. The pneumonic form is invariably fatal unless treated early. It is especially contagious and can trigger severe epidemics through person-to-person contact via droplets in the air.
Historically, plague was responsible for widespread pandemics with high mortality. It was known as the \"Black Death\" during the fourteenth century, causing more than 50 million deaths in Europe. Nowadays, plague is easily treated with antibiotics and the use of standard precautions to prevent acquiring infection.\r\n
People infected with plague usually develop acute febrile disease with other non-specific systemic symptoms after an incubation period of one to seven days, such as sudden onset of fever, chills, head and body aches, and weakness, vomiting and nausea.
As an animal disease, plague is found in all continents, except Oceania. There is a risk of human plague wherever the presence of plague natural foci (the bacteria, an animal reservoir and a vector) and human population co-exist.
Plague epidemics have occurred in Africa, Asia, and South America; but since the 1990s, most human cases have occurred in Africa. The three most endemic countries are the Democratic Republic of Congo, Madagascar, and Peru. In Madagascar cases of bubonic plague are reported nearly every year, during the epidemic season (between September and April).
Confirmation of plague requires lab testing. The best practice is to identify Y. pestis from a sample of pus from a bubo, blood or sputum. A specific Y. pestis antigen can be detected by different techniques. One of them is a laboratory validated rapid dipstick test now widely used in Africa and South America, with the support of WHO.
Untreated pneumonic plague can be rapidly fatal, so early diagnosis and treatment is essential for survival and reduction of complications. Antibiotics and supportive therapy are effective against plague if patients are diagnosed in time. Pneumonic plague can be fatal within 18 to 24 hours of disease onset if left untreated, but common antibiotics for enterobacteria (gram negative rods) can effectively cure the disease if they are delivered early.
Preventive measures include informing people when zoonotic plague is present in their environment and advising them to take precautions against flea bites and not to handle animal carcasses. Generally people should be advised to avoid direct contact with infected body fluids and tissues. When handling potentially infected patients and collecting specimens, standard precautions should apply.
Surveillance and control requires investigating animal and flea species implicated in the plague cycle in the region and developing environmental management programmes to understand the natural zoonosis of the disease cycle and to limit spread. Active long-term surveillance of animal foci, coupled with a rapid response during animal outbreaks has successfully reduced numbers of human plague outbreaks.
In order to effectively and efficiently manage plague outbreaks it is crucial to have an informed and vigilant health care work force (and community) to quickly diagnose and manage patients with infection, to identify risk factors, to conduct ongoing surveillance, to control vectors and hosts, to confirm diagnosis with laboratory tests, and to communicate findings with appropriate authorities.
WHO aims to prevent plague outbreaks by maintaining surveillance and supporting at-risk countries to prepare. As the type of animal reservoir differs according to the region and influences the risk and conditions of human transmission, WHO has developed specific guidelines for the Indian sub-continent, South-America and Sub-Saharan Africa.
Historically, plague was responsible for widespread pandemics with high mortality. It was known as the "Black Death" during the fourteenth century, causing more than 50 million deaths in Europe. Nowadays, plague is easily treated with antibiotics and the use of standard precautions to prevent acquiring infection.
Plague is an infectious disease caused by the bacterium Yersinia pestis.[2] Symptoms include fever, weakness and headache.[1] Usually this begins one to seven days after exposure.[2] There are three forms of plague, each affecting a different part of the body and causing associated symptoms. Pneumonic plague infects the lungs, causing shortness of breath, coughing and chest pain; bubonic plague affects the lymph nodes, making them swell; and septicemic plague infects the blood and can cause tissues to turn black and die.[2][1]
The bubonic and septicemic forms are generally spread by flea bites or handling an infected animal,[1] whereas pneumonic plague is generally spread between people through the air via infectious droplets.[1] Diagnosis is typically by finding the bacterium in fluid from a lymph node, blood or sputum.[2]
Those at high risk may be vaccinated.[2] Those exposed to a case of pneumonic plague may be treated with preventive medication.[2] If infected, treatment is with antibiotics and supportive care.[2] Typically antibiotics include a combination of gentamicin and a fluoroquinolone.[3] The risk of death with treatment is about 10% while without it is about 70%.[4]
Globally, about 600 cases are reported a year.[2] In 2017, the countries with the most cases include the Democratic Republic of the Congo, Madagascar and Peru.[2] In the United States, infections occasionally occur in rural areas, where the bacteria are believed to circulate among rodents.[5] It has historically occurred in large outbreaks, with the best known being the Black Death in the 14th century, which resulted in more than 50 million deaths in Europe.[2]
There are several different clinical manifestations of plague. The most common form is bubonic plague, followed by septicemic and pneumonic plague.[6] Other clinical manifestations include plague meningitis, plague pharyngitis, and ocular plague.[6][7] General symptoms of plague include fever, chills, headaches, and nausea.[1] Many people experience swelling in their lymph nodes if they have bubonic plague.[1] For those with pneumonic plague, symptoms may (or may not) include a cough, pain in the chest, and haemoptysis.[1]
When a flea bites a human and contaminates the wound with regurgitated blood, the plague-causing bacteria are passed into the tissue. Y. pestis can reproduce inside cells, so even if phagocytosed, they can still survive. Once in the body, the bacteria can enter the lymphatic system, which drains interstitial fluid. Plague bacteria secrete several toxins, one of which is known to cause beta-adrenergic blockade.[8]
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