In an eerie throwback to a bygone era, the Peruvian minister of health reported on Monday that a 14 year old boy had died and that at least 31 others had become infected with the plague last week. The vast majority were of the bubonic (lymph node) type – spread by fleas – while a small number suffered from the pneumonic (lung) variety spread by airborne bacteria. Although the plague is treatable with antibiotics, the lack of timely intervention can be deadly, particularly for the pneumonic type. Untreated, the mortality from either form of the plague approaches 75%, and is thought to have been the cause of Black Death – the mid 14th century epidemic that killed over 25 million people, or one third of the population of Europe. Epidemiologists believe that it was the bubonic type, spread by fleas hosted by rats, that was responsible. So far, the cases in Peru have been confined to the Northern coastal province of Ascope, located approximately 325 miles northwest of Lima. The popular international resort of Chicama beach is not far away. Health Minister Oscar Ugarte has ordered authorities to screen sugar, fish and meat exports from this area. There is no vaccine available for the plague. Both the bubonic type, which results in swollen, painful lymph nodes, and the pneumonic type, which causes a rapidly progressive pneumonia, can progress without treatment to involve the entire body. This third, or septic form, results in fever and chills, abdominal pain, vomiting, diarrhea, bleeding from the mouth, nose or rectum, shock and ultimately blackening and death of tissue (gangrene) in the extremities. This darkening of fingers toes

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and the nose lead to the coining of the term “Black Death” over 500 years ago. Anyone who has traveled to an area endemic for the plague should seek immediate medical attention for any flu like symptoms since early treatment with antibiotics is over 90% effective in preventing the more deadly consequences

of this historic illness. Photo by markfftang

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About The Author

Frank Gillingham, M.D. serves as Chief Medical Director for HTH Worldwide. Frank has led HTH Worldwide's international business development efforts in Europe and Canada and has been a guest speaker at international business conferences and has authored a series of articles on travel medicine, including pieces on travel information available on the Internet and the role of physicians working with travel insurers. Frank is a Board-Certified Internist and Emergency Medicine Specialist. He is also a private emergency physician in Southern California and a former emergency department director and member of the UCLA emergency department staff. Frank completed residency training at Los Angeles County/USC Medical Center, received his M.D. from Albert Einstein College of Medicine and his B.A. from the University of Pennsylvania .

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