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The number of actual cases is probably much higher because many countries fail to diagnose and report the plague. The following countries have reported the.
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- Heart failure, the burden of the current plague!
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- Heart failure, the burden of the current plague!
Some improvements in short-term and in-hospital death rates have been observed in recent years. In an analysis of over 6. Despite some ongoing improvement, long-term survival of patients after an episode of acute heart failure also remains poor, with reported 5-year death rates of around 70per cent []. In a community-based study in the USA, the 5-year death rate improved from 57per cent for patients newly diagnosed with heart failure in — to 48per cent for those diagnosed in — Preserved EF was defined as an EF?
For patients, the physical limitations brought about by shortness of breath, loss of energy and fatigue associated with heart failure affect work, social and leisure activities. In addition, family members often feel the burden of caring for a patient with heart failure, and these demands can have physical, emotional and financial effects on them. Maintenance involves adherence to medication and lifestyle changes, while monitoring of the signs and symptoms of heart failure includes activities such as daily weighing to assess fluid retention.
Self-care management means responding appropriately to any changes in symptoms — for example, by increasing the dose of medications prescribed for use as needed. In conclusion, a lot of road has been covered, but otherwise it must be covered to try reducing the burden of this new plague. We should invest a lot of resources in preventing the transition from stage A to the other stages in order to avoid a further increase in the incidence of HF; we should move the management of HF out of the hospitals, with a home-care system employing disease-oriented care-givers or in territorial outpatient clinics, reserving hospitalisation only for the worst cases stage C2-D.
We should build risk models that identify the patients most predisposed to re-hospitalisation so as to be able to intervene to reduce the rate of re-hospitalisation of these categories. Only by implementing these health policies for HF control and management, we will avoid the noteworthy burden of HF not only in terms of mortality, but also in psychological, social and economic terms. Heart disease and stroke statistics— update: a report from the American Heart Association. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.
The annual global economic burden of heart failure. Int J Cardiol.
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Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail ;— The Contribution of preventable acute care spending to total spending for high-cost Medicare patients. JAMA ;—8. National Institute for Clinical Excellence. Chronic heart failure: management of chronic heart failure in adults in primary and secondary care. NICE clinical guideline Adv Ther. The EuroHeart Failure survey programme — a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis.
Eur Heart J ;—63 Eur J Heart Fail ;— Am Heart J ;— National and regional trends in heart failure hospitalisation and mortality rates for Medicare beneficiaries, — JAMA ; — Early and long-term outcomes of heart failure in elderly persons, — Arch Intern Med ;—8. Trends in-length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, — JAMA ;—7.
Improved survival after heart failure: a community-based perspective. J Am Heart Assoc ;2:e This rise is partly attributable to the reappearance of epidemics in countries or regions where human plague had disappeared for several decades. This was the case in in the seaport of Mahajanga Madagascar after an absence of over sixty years, in in Malawi, Zimbabwe, Mozambique and India where no case had been reported during nearly thirty years , in in Zambia and some provinces of China, in in Jordan with no plague cases during eighty years , and more recently in Algeria after over fifty years with no outbreaks.
For this reason, the plague is now categorized as a reemerging disease. Plague primarily affects rodents but several other animal species including cats, rabbits, camels and humans can also be infected. Over rodent species in 73 genera worldwide are susceptible in various degrees to the disease. Sporadically or periodically, explosive outbreaks occur among populations of susceptible rodents. The animal species constituting the natural plague reservoir vary greatly depending on the geographical location of the foci.
For instance, rats represent the common source of human plague cases in Madagascar and Vietnam, while large gerbils in central Kazakhstan and meriones in Iran are the main reservoirs. Plague is generally transmitted via the bites of fleas. Maintenance of plague in nature is totally dependent upon the cyclical transmission between fleas and mammals. More than eighty different species of flea are implicated in maintaining the plague cycle. These species and their transmission efficacy vary from country to country, depending on the characteristics of the ecological niches reservoir species, climate, etc.
The bacteria multiply in the mid gut of the insect, eventually forming a solid mass that blocks its proventriculus. During repeated attempts to feed on a new host, the hungry blocked flea is unable to pump blood into its stomach and subsequently regurgitates the bacteria into the bite wound. The accepted paradigm over the last several decades was that only blocked fleas could efficiently transmit the disease.
However, recent work has demonstrated that Oropsylla montana , the flea commonly found on highly plague-susceptible ground and rock squirrels, and the primary vector to humans in North America, can efficiently and rapidly transmit the disease without any blockage of its proventriculus.
Plague foci exist in a number of countries with landscapes, climates and altitudes that vary considerably. The central Kazakhstan focus, for instance, is a large zone of dry desert at sea level with very hot summers and extremely cold winters. These various ecological niches determine the different types of reservoirs and flea vectors, and consequently influence the incidence of human plague.
This season is usually constant in a given area, but differs from focus to focus, depending on the environmental characteristics climate, altitude, etc. In Madagascar for instance, the plague season is between October and March on the high plateaux, and between July and November on the coast.
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Rodent-to-human plague transmission most commonly occurs via infected fleas associated with peridomestic animals rats, cats or wild rodents. Although rare, infection may also result from direct exposure through conjunctiva or cutaneous excoriations to contaminated fluids or by inhalation of infected aerosols, for instance during the manipulation of animal furs. Human-to-human transmission may occur by inhalation of infected respiratory droplets spread by a patient suffering from pneumonic plague. Differences in the age and sex incidence of bubonic plague cases are observed but are due merely to differences in the degree of exposure of the various groups to the infection rather than to intrinsic causes.
In India, females were more frequently infected, whereas in Manchuria males were at higher risk of infection. Similarly, although plague may more commonly affect one age group, this group is not the same everywhere. Usually, adolescents and adults are considered the most at risk, but the infection predominates in children in several foci such as those of Madagascar and Brazil. The two major clinical forms of plague are bubonic and pneumonic. In the majority of plague attacks, the onset of the disease is sudden and severe.
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It is characterized by a rapid rise in temperature, which reaches Symptoms of alteration of the nervous system are very common and show individual variations characterized by delirium and restless agitation in some patients, and apathy and stupor in others. Vomiting is considered a usual symptom by some physicians, but not so by others.
Unless adequate specific treatment is administered, the condition of the patient deteriorates rapidly and death most commonly occurs within three to five days. Bubonic plague, the most common form of the disease, is acquired after the bite of an infected flea. At the site of the bite, the bacteria multiply and sometimes cause a small vesicle that develops into a painful, dark and necrotic carbuncle. Although not always present, this skin lesion is a valuable indication for the clinical diagnosis of plague. The bacilli then disseminate via the lymphatic vessels and reach the proximal draining lymph node where they multiply, causing an extremely tender tumefaction known as a bubo.
Heart failure, the burden of the current plague!
Although the bubo usually forms at one site only, bilateral and multiple locations are also observed. In the best cases, the bubo spontaneously suppurates and the patient recovers from the infection. Most frequently, the bacterium disseminates via the blood vessels to the spleen, liver and sometimes the lungs, causing septicaemia that is soon fatal.
In patients suffering from a severe type of the infection, localized or diffused skin haemorrhages petechiae or ecchymoses may be a frequent complication. In the absence of appropriate treatment, the mortality rate of bubonic plague victims ranges from 40 to 70 per cent.
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Although less frequent, pneumonic plague is an even more severe form of the disease. Individuals contract it through inhalation of infected droplets spread by a patient who had developed a lung infection, either as a secondary complication of a bubonic form, or after a primary pulmonary contamination. In addition to the general symptoms described above, the patients exhibit signs of lung involvement such as cough, muco-purulent and bloody sputum, dyspnoea and pain in the chest. Without treatment, the outcome of pneumonic plague is invariably fatal, usually in less than three days.
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However, in a number of instances, survival for nine to ten days has been recorded. Besides the classic symptoms characteristic of bubonic and pneumonic plague, Yersinia pestis infection may show various clinical presentations in which septicaemic, meningeal, haemorrhagic, gastro-intestinal, or pharyngeal symptoms predominate. Benign, fulminant and even chronic forms of plague may also exist. Despite this large array of potential clinical symptoms, the plague is, nonetheless, a disease which is easily recognized, not only by physicians, but also by health agents and the population living in endemic areas.
The agent of plague, Yersinia pestis , is a small Gram-negative bacillus belonging to the genus Yersinia. This genus is part of the family Enterobacteriaceae and comprises twelve species, of which only three are human pathogens: Yersinia pestis , Yersinia pseudotuberculosis and Yersinia enterocolitica. Yersinia pseudotuberculosis and Yersinia enterocolitica differ epidemiologically and clinically from Yersinia pestis as they are enteropathogenic bacteria transmitted by the oral route.
Heart failure, the burden of the current plague!
In species where horizontal genetic exchange is rare, sequence polymorphism reflects the accumulation of mutations at a uniform clock rate and correlates with the time elapsed since the existence of a last common ancestor. Using the combination of two different clock rates, it was possible to establish that the Yersinia ancestor appeared 42 to million years ago and that Yersinia enterocolitica and Yersinia pseudotuberculosis diverged from their common ancestor 0.
Most importantly, this study showed that Yersinia pestis is a very recent clone, which emerged from Yersinia pseudotuberculosis within the last to 20, years. Bacteriological identification of Yersinia pestis is carried out on biological samples such as bubo aspirates, blood, sputum, cerebrospinal fluids or organs liver, spleen, lungs following post-mortem examination.
Rapid presumption of plague infection can be obtained by Wayson staining or by a fluorescent antibody test, but confirmation of the diagnosis requires the isolation of the organism. This bacteriological identification may take up to one week and cannot be performed by health agents in the field.
Other techniques have been developed over the last few years to improve the rapidity of plague diagnosis. However, the sensitivity of this technique directly applied on biological samples is not always satisfactory and PCR is not applicable in most field laboratories. This dipstick does not require any sophisticated equipment and is now used routinely by public health agents in Madagascar.
Serological techniques may be useful for retrospective diagnosis when a treatment has been administered to the patient without biological specimens being taken or when no plague bacilli have been isolated from these specimens. The first mass vaccination campaigns against plague were carried out simultaneously in by Georges Girard and Jean-Marie Robic strain EV in Madagascar and by L Otten strain Tjiwidej in Java with live attenuated plague bacilli.