1. BY: KARLA GARCIA JODECI OQUENDO LUIS RIVERA The Bubonic Plague

2. Patient- Abigail Harris 22 year old female reports to a local Hospital center complaining about having chills, fever, muscle pain, and slight swelling in her under arm. Patient started noticing symptoms 4 hours prior to being admitted into the campus health center in the school she attends. She thought she had symptoms of a severe flu, since she traveled to her home country recently.

3. Abigail Harris Is a student in a private law school, and is studying to become a lawyer She reported a sudden death of a relative in her country of origin south Africa, where she also finished coming back from 2 hours prior to being admitted.

4. Exam at the ER Patient was seen by physician at the ER. Was asked for medical History and a physical exam. Medical history reveals she had bone problems in her legs when she was younger, her bones were a bit underdeveloped for her age, but relate to none of her symptoms.

5. Physician Medical doctor. Primary care specialist. PhD in medicine. Training is 4 years of medical school and additional years for residency. This career is designed to diagnose and treat people with medical problems. They make all the decisions when it comes to their patients.

6. Exams Vital signs a little off, not very on point Height: 5’3, Weight: 125, Temp: 103.2°F Swelling in the under arm where there’s a lymph node. High fever, and doesn’t seem to decrease with antibiotics The physician then looks around her body for any open wounds that can be infected.

7. Lymph Nodes The lymph node plays a significant part in the immune system. There is a type of white blood cell in the lymph node that is an antibody, it is released into the blood and acts as the immune system. When an infection is present or a virus other immune system cells are sent to the lymph node to prepare to eliminate the virus, causing the swelling. Lymph nodes are located in the neck, armpits, throat, chest, groin, and abdomen

8. Exams Physician proceeds to examine her body for anything out of the ordinary He then encounters a wound in her under arm, he concludes it might be a “bubo” (enlargement of the lymph gland) that is a vital sign of the bubonic plague. rarediseases.about.com

9. The “bubo” cfmsjohnson.pbworks.com blackdeathfacts.com

10. Patient translated to Intensive care Abigail Harris is then translated on emergency to a different part of the hospital for immediate treatment, she is questioned about her travels, Family members, and home life. She tells the new doctor about her recent arrival from her trip to South Africa for a family death 2 hours prior to being admitted in the health center

11. In the Hospital She also tells them she lives in a rural part of South Africa, which makes it more likely to be exposed to many diseases. Patient also recalls getting a small bug bite in the leg where she felt pain but does not act on the pain until she finally decided to go to the health center.

12. Diagnosis The physician then diagnoses Harris with having the Bubonic Plague, but along with other possible diseases. A rare but existent disease in foreign countries. The physician then refers her to an Infection Disease Doctor, to help with full diagnosis and treatment. Physician also orders blood work to be done, to be sure.

13. Infection Disease Specialist While seeking treatment at a local Hospital, the Infection Disease Specialist conducts several tests, and starts brainstorm immediate out treatment options. Training is 3 years as a doctor of internal medicine, 4 years of medical school and 2-3 specialized training in infectious diseases This career is designed to review medical data and perform physical exams to determine the problem

14. Hospital Treatment The blood work is complete. The doctors are now sure she had been infected with the Bubonic Plague and needs to seek emergency treatment. The Infection Disease Doctor is now present to assist with treatment. The ID Doctor also contacts an epidemiologist.

15. Blood work Up close picture to the blood work done. The cells with the tinted substance show the infection http://healthland.time.com/2011/05/10/first-case-of-bubonic-plague-in-2011-appears- in-new-mexico

16. The Bubonic Plague The plague comes from infected fleas that feed on animals. One of the main carries would be rat fleas, after that fleas can travel to any other animal and it makes it really easy to spread among humans. If left untreated you are more than likely to die from the bubonic plague.

17. Animals that carry the disease http://en.wikipedia.org/wiki/File:Flea_infected_with_yersinia _pestis.jpg http://2.bp.blogspot.com/- Ar8Sm3Mknx0/TmfvMm0iQnI/AAAAAAAAB2Q/ZPPun GL3wzM/s1600/rat.jpg

18. Bubonic Plague The disease was discovered during the early 16 th century, in Europe. There was huge epidemic and caused people to die in huge masses. There was stories written about it, such as “The Masque of the Red Death” by Edgar Allen Poe. Bubonic plague victims in a mass grave from 1720-1721 in Martigues, France

19. Bubonic Plague “Black Death” The disease was also referred to as the “Black Death” Killing millions of people in the blink of an eye. Once infected with this disease you start to show symptoms of it 2-6 hours after infection, in rare cases even up to 6 days. The most significant symptom of the bubonic plague is the swelling of the lymph gland called a “bubo”, it is commonly found in the groin, but can also occur in the armpits or neck, most likely at the site of the infection or bite

20. Symptoms Chills Fever General ill feeling Headache Muscle pain Seizures Smooth, painful lymph gland swelling called a ”bubo”  Pain may occur in the area before the swelling appears

21. Infection Transmission The plague comes from infected fleas that feed on animals. One of the main carries would be rat fleas, after that fleas can travel to any other animal and it makes it really easy to spread among humans. You may also be exposed to the virus by cats, dogs, and many other animals. If left untreated you are more than likely to die from the bubonic plague.

22. Infection Treatment The most common antibiotics to treat the bubonic plague would be, striptomycin, gentamicin, doxycycline, or ciproflaxcin. In addition to the antibiotics, the patient must be kept in the Hospital, with oxygen, an IV to induce fluids into her body, and respiratory support might be necessary, as her infection has happened hours ago, there is no time to waste.

23. Streptomycin A drug used to treat patients with an infection created by microorganism. Usually used to treat tuberculosis, another infection brought similar to the plague. This drug is used to treat severe cases, for other non high risk infections this drug would not be commonly prescribed.

24. Gentamicin This drug is mainly to fight bacteria in the body, brought on by infections. Only for severe or serious infections. This is usually prescribed for a certain amount of time, and should not be taken off the regulated schedule. Indications:  1.5 to 2 mg/kg loading dose, followed by 1 to 1.7 mg/kg IV or IM every 8 hours or 5 to 7 mg/kg IV every 24 hours.

25. Doxycycline Doxycycline is a medication prescribed to treat bacterial infections Works to prevent the growth and spread of the bacteria It comes as a tablet, a syrup, and a liquid all taken orally Doses depend upon doctor’s request

26. Ciproflaxcin Ciprofloxacin is used to treat or prevent certain infections caused by bacteria Works by killing bacteria that causes the infection It comes as a tablet, a liquid, and an extended- release tablet to be taken orally Doses and brands depend upon doctor’s request

27. Goal of treatment The goal, at this point for the patient would be to save her life, and prevent the evolving of the disease as it can become worse and harder to treat. Prevent spread amongst people she knows Develop better treatments in case another patient with the plague shows up.

28. Prevention/ Control When traveling to foreign places, be informed. Also be aware of any animals that may bite you, if so seek medical attention immediately. Stay away from rodents and other animals that you are not familiar with when traveling. A vaccination is also available, but might not be 100% effective to prevent this infection.

29. Epidemiologist An epidemiologist is a doctor that investigates the cause of the disease and other health problems to control and prevent them from spreading Education requirements include a master’s degree from a school of public health and a Ph.D. or medical degree

30. Epidemiologist’s results Her family lives in a rural part of South Africa. They have many animals and are exposed to rodents everyday. When she went to visit, due to the death of a loved one she slept in a low quality hotel to save money. Particularly exposed to rodents and other animals. This is more than likely where she retrieved the infection. A small flea could have bit her as she was leaving the country to board a plane back the U.S.

31. The Plague There are two more types of the Plague. Pneumonic Plague- infection of the lungs  Symptoms:  Cough  Difficulty breathing  Fever  Frothy, bloody sputum  Pain in the chest when you breathe deeply  Severe cough

32. The Plague Septicemic Plague- infection of the blood.  Symptoms:  Abdominal pain  Bleeding due to blood clotting problems  Diarrhea  Fever  Nausea  Vomiting Death can occur before the symptoms even show.

33. Abigail after After going under treatment for the bubonic plague, the patient has a made a full recovery. The medication used to treat her infection have worked as projected and she is now rid of the infection in her body. Graduated from law school. Plans to open a firm.

34. Bibliography "Plague: MedlinePlus Medical Encyclopedia." National Library of Medicine - National Institutes of Health. N.p., n.d. Web. 2 June 2012. <http://www.nlm.nih.gov/medlineplus/ "Bubonic Plague." About.com Rare Diseases. N.p., n.d. Web. 02 June 2012.. "CDC Plague Home Page - CDC Division of Vector-Borne Infectious Diseases (DVBID)." Centers for Disease Control and Prevention. N.p., n.d. Web. 2 June 2012. <http://www.cdc.gov/ncidod/dvbid/plag "The Black Death: Bubonic Plague."Middle Ages - Medieval Resources. N.p., n.d. Web. 7 Feb. 2012. <http://www.themiddleages.net/plague.htm "First Case of Bubonic Plague in 2011 Appears in New Mexico | Healthland | TIME.com." Healthland | A healthy balance of the mind, body and spirit | TIME.com. N.p., n.d. Web. 7 Feb. 2012..

35. Bibliography "Plague : The Lancet." TheLancet.com - Home Page. N.p., n.d. Web. 2 June 2012.. C., Zach D. & Will. "CFMS Mrs. Johnson- Language Arts / The Plague- period 6." CFMS Mrs. Johnson- Language Arts / FrontPage. N.p., n.d. Web. 2 June 2012.. "Black death symptoms." Black Death Facts. N.p., n.d. Web. 3 June 2012.. "Lymph Node Location : underarms, groin, neck, chest and abdomen.."Lymph Node. N.p., n.d. Web. 7 June 2012.. "gentamicin medical facts from Drugs.com." Drugs.com | Prescription Drug Information, Interactions & Side Effects. N.p., n.d. Web. 7 June 2012. <http://www.drugs.com/mtm/gentamicin.h