Plague

Plague is a severe bacterial infection that may cause death.

Causes

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

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

Plague lung infection is called pneumonic plague. It can be spread from person to person. 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 can be started this way.

In the Middle Ages in Europe, massive plague epidemics killed millions of people. Plague has not been eliminated. It 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 8 days. But the time can 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.

Symptoms

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

• Fever and chills
• General ill feeling (malaise)

  Malaise

  Malaise is a general feeling of discomfort, illness, or lack of well-being.

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• Headache
• Muscle pain
• Seizures

  Seizures

  A seizure is the physical changes in behavior that occurs after an episode of abnormal electrical activity in the brain. The term "seizure" is often ...

  

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• Smooth, painful lymph gland swelling called a bubo that is 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 start before the swelling appears

  Bubo

  Chancroid is a bacterial infection that is spread through sexual contact.

  

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Pneumonic plague symptoms appear suddenly, typically 1 to 4 days after exposure. They include:

• Severe cough
• Difficulty breathing and pain in the chest when breathing deeply
• Fever and chills
• Headache
• Frothy, bloody sputum

  Bloody sputum

  Coughing up blood is the spitting up of blood or bloody mucus from the lungs and throat (respiratory tract). Hemoptysis is the medical term for cough...

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

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

Exams and Tests

The health care provider will perform a physical examination and ask about your symptoms.

Tests that may be done include:

• Blood culture

  Blood culture

  A blood culture is a laboratory test to check for bacteria or other germs in a blood sample.

  

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

  Culture of lymph node aspirate

  Lymph node culture is a laboratory test done on a sample from a lymph node to identify germs that cause infection.

  

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• Sputum culture

  Sputum culture

  Routine sputum culture is a laboratory test that looks for germs that cause infection. Sputum is the material that comes up from air passages when y...

  

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• Chest x-ray

Treatment

People with the plague need to be treated right away. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases.

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

Respiratory

The words "respiratory" and "respiration" refer to the lungs and breathing.

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People with pneumonic plague must be kept away from other patients and isolation procedures will be followed in the hospital. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

Outlook (Prognosis)

Without treatment, about 50% of people with bubonic plague die. Almost everyone with septicemic or pneumonic plague dies if not treated right away. Treatment reduces the death rate to 50%.

When to Contact a Medical Professional

Contact your provider if you develop plague symptoms after exposure to fleas or rodents. Contact your provider if you live in or have visited an area where plague occurs.

Prevention

Rat control and watching for the disease in the wild rodent population are the main measures used to control the risk for epidemics. The plague vaccine is no longer used in the United States.