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What is known about the suspicion of bubonic plague in Rio and why fear is fear – 01/15/2019



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A 57-year-old woman living in São Gonçalo, a municipality in Rio de Janeiro, is hospitalized with suspicion of bubonic plague (or black plague), a disease that was not reported in Brazil since 2005, when there was a unique case at Municipality of Pedra Branca, in the mountainous area of ​​Ceará.

On December 22 of last year, the patient entered the Central Room of São Gonçalo Emergencies with heart failure. He then referred to the hospital, Luiz Palmier, where oral, nasal and anal materials were collected for analysis.

Due to a skin wound, a skin sample was also requested, which diagnosed the presence of the bacterium Yersinia pestis, which caused the disease that affected Europe in the 14th century. Historians estimate that 25 million people, more than a third of the population of the continent at the time, died as a result of the pathology between 1347 and 1351.

According to the prefecture of the city of Rio de Janeiro, the antibiotics were immediately started and the woman was followed in a bed of isolation to prevent the spread of the disease, if confirmed.

Despite the concern, the Ministry of Health informed BBC News Brazil, by note, that this case does not comply with the definition of suspect, as the clinical picture presented is not in accordance with the description of the bubonic plague. There are all reasons to believe that there was an error in the identification of the bacillus in the first test.

The MS also reported that the Central Public Health Laboratory (LACEN) of the State of Rio de Janeiro reconsidered the analysis and identified the Morganella morganni bacteria, a microorganism widely distributed in the environment and that It does not cause infections in individuals with good immunity.

Already in people with an immune compromise they can cause opportunistic contamination of the respiratory and urinary tracts and infect wounds.

In addition, laboratory samples were collected and sent to the Research Center Aggeu Magalhães (CPqAM) of the Oswaldo Cruz Foundation (Fiocruz / Pernambuco) for a subsequent analysis and closure of the research. There is no prediction about when the result will be published.

As a precautionary measure, a team of zoonoses controlling the Environmental Monitoring of the city of São Gonçalo also went to the patient's house to carry out inspection of pests and rodents, and did not find traces.

What is plague?

Plague is an acute infectious disease that manifests itself in three clinical forms: bubonic, septicemic and pneumonia. It is transmitted mainly by bites of infected fleas present in rodents, especially mice.

Estevão Portela Nunes, an infectologist and deputy director of Clinical Services at the National Institute of Evandro Chagas Infection (INI / Fiocruz), explains that bubonic is the type of pathology that is milder and the most important symptoms are fever high and enlarged glands) and painful near the sting site.

In later stages, the lymph nodes usually open and full of contagious secretions.

"This condition can progress and eventually cause other forms." Pneumonia occurs when the infection reaches the lungs. Septicemia is when bacteria fall into the bloodstream and spread throughout the body, "says the specialist.

It should be mentioned that, in the case of pneumonia, there is an aggravation if it is transmitted from person to person through objects infected with mucosities and aerogenic droplets released by coughing to the environment.

According to the Ministry of Health, "the greater transmissibility of the bubonic plague occurs in the symptomatic period, where the bacilli circulates in the body in greater quantities." The pneumonic plague occurs at the beginning of the sputum, remaining as long as there is bacteria in the respiratory tract. Incubation time is usually 2 to 6 days in the bubonic phase and from 1 to 3 days in pneumonia.

The diagnosis of the disease is done through blood tests, the liquid present in the bubbles or the sputum. Nunes says that the treatment should start as soon as possible, even before the laboratory results arrive, ideally, it should be restored within 15 hours after the appearance of the Symptoms of the severity and rapidity of the clinical picture.

It is manufactured with the use of antibiotics (tetracycline, streptomycin, chloramphenicol are some), injectable or oral, for a period of 10 to 14 days. Hospital hospitalization and patient isolation are often necessary from the outset to define the best behavior and follow the evolution of the case.

"Although it is a potentially dangerous disease, it is no longer so deadly and we are now armed against it," says Nunes. The lethality, when not treated properly, varies from 30% to 60%.

To avoid plague, as there is no vaccine, it is important to take basic sanitation measures, not accumulate and sweep and make your collection correctly. Therefore, it avoids the proliferation of rodents.

The MS also recommends that there is no contact with sinanctrous animals: those who have adapted to live with the man, despite their doves due to the flames found in them.

Origin

There is no consensus on the origin of Black Death, but the most common is that it originated in China or Central Asia and was transported to Europe with fleas and rats traveling on merchant ships.

Currently, most cases of the disease are registered in rural areas and remain potentially dangerous in various parts of the world, especially in Africa, Congo and the island of Madagascar. You have also reported isolated events in the last years in the United States and Peru.

In Brazil, as indicated in the website of the Ministry of Health, there are two areas considered natural: the northeast, distributed in the states of Ceará, Rio Grande do Norte, Paraíba, Pernambuco (with a small extension to Piauí), Alagoas and Bahia, and that of Teresópolis, in Rio de Janeiro.

The MS reports that "there are still other areas of pestilence located in the mining territory of the River Twelve Valley and the Jequitinhonha Valley, which can be considered as an extension of the North East focus."

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