Plague is a severe and potentially deadly bacterial infection.

Bubonic plague; Pneumonic plague; Septicemic plague

Plague is caused by the bacteria Yersinia pestis. Rodents, such as rats, carry the disease. It is spread by their fleas.

People can get the plague when they are bitten by a flea that carries the plague bacteria from an infected rodent. In rare cases, you may get the disease when handling an infected animal.

A plague lung infection called pneumonic plague can spread from human to human. When someone with pneumonic plague coughs, tiny droplets carrying the bacteria move through the air. Anyone who breathes in these particles may catch the disease. An epidemic may be started this way.

In the Middle Ages in Europe, massive plague epidemics killed millions of people. Plague can still be found in Africa, Asia, and South America.

Today, plague is rare in the United States, but it has been known to occur in parts of California, Arizona, Colorado, and New Mexico.

There three most common forms of plague are:

• Bubonic plague -- an infection of the lymph nodes
• Pneumonic plague -- an infection of the lungs
• Septicemic plague -- an infection of the blood

The time between being infected and developing symptoms is typically 2 to 7 days, but may be as short as 1 day for pneumonic plague.

Risk factors for plague include a recent flea bite and exposure to rodents, especially rabbits, squirrels, or prairie dogs, or scratches or bites from infected domestic cats.

Bubonic plague symptoms appear suddenly, usually after 2 - 5 days of exposure to the bacteria. Symptoms include:

• Chills
• Fever
• General ill feeling (malaise)
• Headache
• Muscle pain
• Seizures
• Smooth, painful lymph gland swelling called a bubo
  • Commonly found in the groin, but may occur in the armpits or neck, most often at the site of the infection (bite or scratch)
  • Pain may occur in the area before the swelling appears

Pneumonic plague symptoms appear suddenly, typically 2 - 3 days after exposure. They include:

• Cough
• Difficulty breathing
• Fever
• Frothy, bloody sputum
• Pain in the chest when you breathe deeply
• Severe cough

Septicemic plague may cause death even before its symptoms occur. Symptoms can include:

• Abdominal pain
• Bleeding due to blood clotting problems
• Diarrhea
• Fever
• Nausea
• Vomiting

Tests that may be done include:

• Blood culture
• Culture of lymph node aspirate (fluid taken from an affected lymph node or bubo)
• Sputum culture

People with the plague need immediate treatment. If treatment is not received within 24 hours of when the first symptoms occur, death may occur.

Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague. Oxygen, intravenous fluids, and respiratory support usually are also needed.

Patients with pneumonic plague should be strictly isolated from caregivers and other patients. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

Without treatment, about 50% of people with bubonic plague die. Almost all people with pneumonic plague die if not treated. Treatment reduces the death rate to 50%.

Call your health care provider if you develop plague symptoms after exposure to fleas or rodents, especially if you live in or have visited an area where plague occurs.

Rat control and watching for the disease in the wild rodent population are the main measures used to control the risk of epidemics. A vaccination is available for high-risk workers, but its effectiveness is not clearly established.

Dennis DT, Mead PS, Yersinia species, including plague. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 229.

Gage KL. Plague and other Yersinia infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 333.