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Plague

(Pneumonic Plague; Bubonic Plague; Septicemic Plague; Pharyngeal Plague)

Definition

Plague is a bacterial infection. It needs to be treated right away.

There are three types:

  • Bubonic is the most common. It affects the lymph nodes.
  • Pneumonic is rare. It affects the lungs and is often fatal.
  • Septicemic involves the blood.

Causes

Certain bacteria cause plague. How it spreads depends on the type.

  • Bubonic and septicemic types are spread from:
    • The bite of an infected flea or louse
    • Contact with bodily fluids from a sick person or animal
  • Pneumonic type is caused by breathing it in—after an infected person coughs or sneezes

Spreading Pneumonic Plague

Breathing in droplets from an infected person.

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Risk Factors

Plague is most common in parts of Africa. It is rare but can be found in the southwestern and western U.S. and other parts of the world. Risk is highest for those who live in or travel to these places.

Other things that raise the risk are:

  • Having contact with an infected person
  • Working with animals
  • Getting a flea or louse bite

Symptoms

Symptoms of plague are:

Bubonic Type:

  • Fever and chills
  • Weakness
  • Swollen, tender lymph nodes

Pneumonic Type:

  • Fever
  • Breathing problems
  • Cough with bloody mucus
  • Chest pain

Septicemic Type:

  • Fever and chills
  • Lightheadedness
  • Weakness
  • Bleeding under the skin
  • Black fingers, toes, or nose

Diagnosis

The doctor will ask about your symptoms, and health and travel history. A physical exam may be done. Tests may be done to find the bacteria. They may be:

  • Blood or saliva tests
  • Spinal tap—to test spinal fluid
  • Lymph fluid—from a swollen lymph node

Chest x-rays may be done to check for lung problems.

Treatment

The goal is to treat the infection right away. This can be done with IV and oral antibiotics.

If the lungs are involved—oxygen and breathing support may be needed.

Treatment usually lasts about 10 to 14 days.

Prevention

The risk of plague may be lowered by:

  • Taking antibiotics after a known exposure
  • Wearing a mask—when near those who are infected
  • Keeping rodents out of the home
  • Using flea control on pets
RESOURCES:

Centers for Disease Control and Prevention
https://www.cdc.gov

National Institute of Allergy and Infectious Diseases
https://www.niaid.nih.gov

CANADIAN RESOURCES:

Alberta Health Services
https://www.albertahealthservices.ca

Public Health Agency of Canada
https://www.canada.ca

REFERENCES:

Pechous RD, Sivaraman V, et al. Pneumonic plague: the darker side of yersinia pestis. Trends Microbiol. 2016;24(3):190-197.

Plague. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/plague. Accessed February 5, 2021.

Plague. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/plague. Accessed February 5, 2021.

Last reviewed September 2020 by David L. Horn, MD, FACP  Last Updated: 2/5/2021