Pneumonic plague

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Pneumonic plague
Yersinia pestis.jpg
A scanning electron micrograph depicting a mass of Yersinia pestis bacteria.
Specialty Infectious disease
SymptomsFever, headache, shortness of breath, cough [1]
Usual onset3 to 7 days [2]
Causes Yersinia pestis [3]
Risk factors Rodents [3]
Diagnostic method Sputum testing [1]
Treatment Antibiotics [1]
FrequencyRare [2]

Pneumonic plague is a severe lung infection caused by the bacterium Yersinia pestis . [3] Symptoms include fever, headache, shortness of breath, chest pain, and cough. [1] They typically start about three to seven days after exposure. [2] It is one of three forms of plague, the other two being septicemic plague and bubonic plague. [3]

<i>Yersinia pestis</i> species of bacteria, cause of plague

Yersinia pestis is a gram-negative, nonmotile, rod-shaped coccobacillus bacteria, with no spores. It is a facultative anaerobic organism that can infect humans via the Oriental rat flea. It causes the disease plague, which takes three main forms: pneumonic, septicemic and bubonic plagues. All three forms were responsible for a number of high-mortality epidemics throughout human history, including: the sixth century's Plague of Justinian; the Black Death, which accounted for the death of at least one-third of the European population between 1347 and 1353; and the Third Pandemic, sometimes referred to as the Modern Plague, which began in the late nineteenth century in China and spread by rats on steamboats claiming close to 10,000,000 lives. These plagues likely originated in China and were transmitted west via trade routes. Recent research indicates that the pathogen may have been the cause of what is described as the Neolithic Decline, when European populations declined significantly. This would push the date to much earlier and might be indicative of an origin in Europe rather than Eurasia.

Fever common medical sign characterized by elevated body temperature

Fever, also known as pyrexia and febrile response, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using values between 37.5 and 38.3 °C. The increase in set point triggers increased muscle contractions and causes a feeling of cold. This results in greater heat production and efforts to conserve heat. When the set point temperature returns to normal, a person feels hot, becomes flushed, and may begin to sweat. Rarely a fever may trigger a febrile seizure. This is more common in young children. Fevers do not typically go higher than 41 to 42 °C.

Shortness of breath, also known as dyspnea, is the feeling that one cannot breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity", and recommends evaluating dyspnea by assessing the intensity of the distinct sensations, the degree of distress involved, and its burden or impact on activities of daily living. Distinct sensations include effort/work, chest tightness, and air hunger.


The pneumonic form may occur following an initial bubonic or septicemic plague infection. [3] It may also result from breathing in airborne droplets from another person or cat infected with pneumonic plague. [1] The difference between the forms of plague is the location of infection; in pneumonic plague the infection is in the lungs, in bubonic plague the lymph nodes, and in septicemic plague within the blood. [3] Diagnosis is by testing the blood, sputum, or fluid from a lymph node. [1]

Airborne disease disease that is caused by pathogens and transmitted through the air

An airborne disease is any disease that is caused by pathogens that can be transmitted through the air. Such diseases include many of considerable importance both in human and veterinary medicine. The relevant pathogens may be viruses, bacteria, or fungi, and they may be spread through breathing, talking, coughing, sneezing, raising of dust, spraying of liquids, toilet flushing or any activities which generates aerosol particles or droplets. Human airborne diseases do not include conditions caused by air pollution such as Volatile Organic Compounds (VOCs), gases and any airborne particles, though their study and prevention may help inform the science of airborne disease transmission.

While vaccines are being worked on, in most countries they are not yet commercially available. [1] [3] Prevention is by avoiding contact with infected rodents, people, or cats. [1] [3] It is recommended that those infected be isolated from others. [2] Treatment of pneumonic plague is with antibiotics. [1]

Vaccine biological preparatory medicine that improves immunity to a particular disease

A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future. Vaccines can be prophylactic, or therapeutic.

Isolation (health care) various measures taken to prevent contagious diseases from being spread

In health care facilities, isolation represents one of several measures that can be taken to implement infection control: the prevention of contagious diseases from being spread from a patient to other patients, health care workers, and visitors, or from outsiders to a particular patient. Various forms of isolation exist, in some of which contact procedures are modified, and others in which the patient is kept away from all others. In a system devised, and periodically revised, by the U.S. Centers for Disease Control and Prevention (CDC), various levels of patient isolation comprise application of one or more formally described "precaution".

Plague is present among rodents in Africa, the Americas, and Asia. [3] Pneumonic plague is more serious and less common than bubonic plague. [1] The total reported number of all types of plague in 2013 was 783. [2] Untreated pneumonic plague has a mortality of nearly 100%. [3] Some hypothesize that the pneumonic version of the plague was mainly responsible for the Black Death that resulted in approximately 50 million deaths in the 1300s. [4] [2]

Black Death Pandemic in Eurasia in the 1300s

The Black Death, also known as the Great Plague, the Black Plague, or the Plague, was one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people in Eurasia and peaking in Europe from 1347 to 1351. The bacterium Yersinia pestis, which results in several forms of plague, is believed to have been the cause. The Black Death was the first major European outbreak of plague, and the second plague pandemic. The plague created a number of religious, social and economic upheavals which had profound effects on the course of European history.

Signs and symptoms

The most apparent symptom of pneumonic plague is coughing, often with hemoptysis (coughing up blood). With pneumonic plague, the first signs of illness are fever, headache, weakness and rapidly developing pneumonia with shortness of breath, chest pain, cough and sometimes bloody or watery sputum. [5]

Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions. Hemoptysis is considered massive at 300 mL. In such cases, there are always severe injuries. The primary danger comes from choking, rather than blood loss.

Sputum mucus that is coughed up from the lower airways

Sputum is mucus and is the name used for the coughed-up material (phlegm) from the lower airways. In medicine, sputum samples are usually used for naked eye exam, microbiological investigations of respiratory infections, and cytological investigations of respiratory systems. It is critical that the patient not give a specimen that includes any mucoid material from the interior of the nose. Naked eye exam of sputum can be done at home by a patient in order to note the various colors. Any hint of yellow color suggests an airway infection. Such color hints are best detected when the sputum is viewed on a very white background such as white paper, a white pot, or a white sink surface. The more intense the yellow color, the more likely it is a bacterial infection.

The pneumonia progresses for two to four days and may cause respiratory failure and shock. Patients will die without early treatment, some within 36 hours.

Shock is the state of not enough blood flow to the tissues of the body as a result of problems with the circulatory system. Initial symptoms may include weakness, fast heart rate, fast breathing, sweating, anxiety, and increased thirst. This may be followed by confusion, unconsciousness, or cardiac arrest as complications worsen.

Initial pneumonic plague symptoms can often include the following:

Rapidly developing pneumonia with:


Pneumonic plague can be caused in two ways: primary, which results from the inhalation of aerosolised plague bacteria, or secondary, when septicaemic plague spreads into lung tissue from the bloodstream. Pneumonic plague is not exclusively vector-borne like bubonic plague; instead it can be spread from person to person. There have been cases of pneumonic plague resulting from the dissection or handling of contaminated animal tissue. This is one type of the plague formerly known as the Black Death. [6]


Pneumonic plague is a very aggressive infection requiring early treatment. Antibiotics must be given within 24 hours of first symptoms to reduce the risk of death. [5] Streptomycin, gentamicin, tetracyclines and chloramphenicol are all effective against pneumonic plague.

Antibiotic treatment for seven days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection. [5]

The mortality rate from untreated pneumonic plague approaches 100%. [7]


Since 2002, the World Health Organization (WHO) has reported seven plague outbreaks, though some may go unreported because they often happen in remote areas. Between 1998 and 2009, nearly 24,000 cases have been reported, including about 2,000 deaths, in Africa, Asia, the Americas, and Eastern Europe. Ninety-eight percent of the world's cases occur in Africa.


In September 1994, India experienced an outbreak of plague that killed 50 and caused travel to New Delhi by air to be suspended until the outbreak was brought under control. [8] The outbreak was feared to be much worse because the plague superficially resembles other common diseases such as influenza and bronchitis; over 200 people that had been quarantined were released when they did not test positive for the plague. [9] All but two of the deaths occurred around the city of Surat.


The People's Republic of China has eradicated the pneumonic plague from most parts of the country, but still reports occasional cases in remote Western areas where the disease is carried by rats and the marmots that live across the Himalayan plateau. Outbreaks can be caused when a person eats an infected marmot or comes into contact with fleas carried by rats. A 2006 WHO report from an international meeting on plague cited a Chinese government disease expert as saying that most cases of the plague in China's northwest occur when hunters are contaminated while skinning infected animals. [10]

The expert said at the time that due to the region's remoteness, the disease killed more than half the infected people. The report also said that since the 1990s, there was a rise in plague cases in humans—from fewer than 10 in the 1980s to nearly 100 cases in 1996 and 254 in 2000. [11] In September 2008, two people in east Tibet died of pneumonic plague. [12]

An outbreak of the disease in China began in August 2009 in Ziketan Town located in Qinghai Province. The town was sealed off and several people died as a result of the disease. [10] [13] According to spokesperson Vivian Tan of the WHO office in Beijing, "In cases like this [in August 2009], we encourage the authorities to identify cases, to investigate any suspicious symptoms among close contacts, and to treat confirmed cases as soon as possible. So far, they have done exactly that. There have been sporadic cases reported around the country in the last few years so the authorities do have the experience to deal with this." [14]

In September 2010, five cases of pneumonic plague were reported in Tibet. [15]

In July 2014, Chinese media reported one case found in Gansu. [16]


In August 2010, Peru's health minister Oscar Ugarte announced that an outbreak of plague had killed a 14-year-old boy and had infected at least 31 people in a northern coastal province. The boy died of bubonic plague on 26 July 2010. Ugarte stated that authorities were screening sugar and fish meal exports from Ascope Province, located about 325 miles (520 km) northwest of Lima, not far from popular Chicama beach. Most of the infections in Peru were bubonic plague, with four cases of pneumonic plague. [17]

The first recorded plague outbreak in Peru was in 1903. The last, in 1994, killed 35 people. [18]


Medical team working together during the plague period in Madagascar (October, 2017). Medical team working together during the plague period in Madagascar.jpg
Medical team working together during the plague period in Madagascar (October, 2017).

An outbreak of plague in November 2013, occurred in the African island nation of Madagascar. [19] As of 16 December, at least 89 people were infected, with 39 deaths [20] with at least two cases involving pneumonic plague. However, as many as 90% of cases were later reported to have involved pneumonic plague. [21] From 23 August to 30 September 2017, a total of 73 suspected, probable, and confirmed cases of pneumonic plague, including 17 deaths, were reported in Madagascar. [22] The diagnosis was confirmed by the Institut Pasteur de Madagascar by polymerase chain reaction test or using rapid diagnostic test. The WHO and Institut Pasteur were both involved in administering antibiotic compounds and attempting to stop the spread of the disease. By mid-October there were an estimated 684 confirmed cases of plague with 474 pneumonic, 156 bubonic and one septicemic. The remainder were not classified. At least 74 deaths have been ascribed to pneumonic plague. [23]

United States

In the fall of 1924, an outbreak occurred in Los Angeles that killed 30 people.

On November 2, 2007, wildlife biologist Eric York died of pneumonic plague in Grand Canyon National Park. York was exposed to the bacteria while conducting a necropsy on a mountain lion carcass. [24]

In 2014, the Colorado Department of Public Health and Environment confirmed that a Colorado man had been diagnosed with pneumonic plague, the first confirmed human case in Colorado in more than ten years, and one of only 60 cases since 1957. The man was found to have the disease after the family dog died unexpectedly and a necropsy revealed that the dog had died from the disease. [25] Three additional pneumonic plague cases were confirmed in Colorado before the outbreak ended. [26] The outbreak was caused by a pit bull. [27]

Related Research Articles

Plague (disease) contagious and frequently fatal human disease

Plague is an infectious disease caused by the bacterium Yersinia pestis. Symptoms include fever, weakness and headache. Usually this begins one to seven days after exposure. In the bubonic form there is also swelling of lymph nodes, while in the septicemic form tissues may turn black and die, and in the pneumonic form shortness of breath, cough and chest pain may occur.

Pandemic global epidemic of infectious disease

A pandemic is an epidemic of disease that has spread across a large region; for instance multiple continents, or even worldwide. This may include communicable and noncommunicable diseases.

Measles Viral disease affecting humans

Measles is a highly contagious infectious disease caused by the measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Rubella, which is sometimes called German measles, and roseola are different diseases caused by unrelated viruses.

Whooping cough human disease caused by the bacteria Bordetella pertussis

Whooping cough is a highly contagious bacterial disease. Initially, symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough. This is followed by weeks of severe coughing fits. Following a fit of coughing, a high-pitched whoop sound or gasp may occur as the person breathes in. The coughing may last for 10 or more weeks, hence the phrase "100-day cough". A person may cough so hard that they vomit, break ribs, or become very tired from the effort. Children less than one year old may have little or no cough and instead have periods where they do not breathe. The time between infection and the onset of symptoms is usually seven to ten days. Disease may occur in those who have been vaccinated, but symptoms are typically milder.

Hand, foot, and mouth disease human disease

Hand, foot, and mouth disease (HFMD) is a common infection caused by a group of viruses. It typically begins with a fever and feeling generally unwell. This is followed a day or two later by flat discolored spots or bumps that may blister, on the hands, feet and mouth and occasionally buttocks and groin. Signs and symptoms normally appear 3–6 days after exposure to the virus. The rash generally resolves on its own in about a week. Fingernail and toenail loss may occur a few weeks later, but they will regrow with time.

Tularemia primary bacterial infectious disease that has material basis in Francisella tularensis, which is transmitted by dog tick bite (Dermacentor variabilis), transmitted by deer flies (Chrysops sp) or transmitted by contact with infected animal tissues.

Tularemia, also known as rabbit fever, is an infectious disease caused by the bacterium Francisella tularensis. Symptoms may include fever, skin ulcers, and enlarged lymph nodes. Occasionally, a form that results in pneumonia or a throat infection may occur.

Septicemic plague Human disease

Septicemic plague is one of the three main forms of plague. It is caused by Yersinia pestis, a gram-negative species of bacterium. Septicemic plague is a life-threatening infection of the blood, most commonly spread by bites from infected fleas.

Listeriosis bacterial infection

Listeriosis is a bacterial infection most commonly caused by Listeria monocytogenes, although L. ivanovii and L. grayi have been reported in certain cases. Listeriosis can cause severe illness, including severe sepsis, meningitis, or encephalitis, sometimes resulting in lifelong harm and even death. Those at risk of severe illness are the elderly, unborn babies, newborns and those who are immunocompromised. In pregnant women it may cause stillbirth or spontaneous abortion, and preterm birth is common. Listeriosis may cause mild, self-limiting gastroenteritis and fever in anyone.

Third plague pandemic pandemic

Third Pandemic is the designation of a major bubonic plague pandemic that began in Yunnan province in China in 1855. This episode of bubonic plague spread to all inhabited continents, and ultimately more than 12 million people died in India and China, with about 10 million killed in India alone. According to the World Health Organization, the pandemic was considered active until 1960, when worldwide casualties dropped to 200 per year.

Canine influenza influenza occurring in canine animals

Canine influenza is influenza occurring in canine animals. Canine influenza is caused by varieties of influenzavirus A, such as equine influenza virus H3N8, which in 2004 was discovered to cause disease in dogs. Because of the lack of previous exposure to this virus, dogs have no natural immunity to it. Therefore, the disease is rapidly transmitted between individual dogs. Canine influenza may be endemic in some regional dog populations of the United States. It is a disease with a high morbidity but a low incidence of death.

The Great Plague of Seville (1647–1652) was a massive outbreak of the disease in Spain that killed up to a quarter of Seville's population.

Bubonic plague Human and animal disease

Bubonic plague is one of three types of plague caused by bacterium Yersinia pestis. One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting. Swollen and painful lymph nodes occur in the area closest to where the bacteria entered the skin. Occasionally, the swollen lymph nodes may break open.

Theories of the Black Death are a variety of explanations that have been advanced to explain the nature and transmission of the Black Death (1347–51). A number of epidemiologists and since the 1980s have challenged the traditional view that the Black Death was caused by plague based on the type and spread of the disease. The confirmation in 2010 and 2011 that Yersinia pestis DNA was associated with a large number of plague sites has renewed focus on plague as the leading hypothesis, but has not yet led to a final resolution of all these questions.

Acute exacerbation of chronic obstructive pulmonary disease

Acute exacerbation of COPD is a sudden worsening of COPD symptoms that typically lasts for several days. It may be triggered by an infection with bacteria or viruses or by environmental pollutants. Typically, infections cause 75% or more of the exacerbations; bacteria can roughly be found in 25% of cases, viruses in another 25%, and both viruses and bacteria in another 25%. Airway inflammation is increased during the exacerbation resulting in increased hyperinflation, reduced expiratory air flow and decreased gas exchange.

Ziketan Town Town in Qinghai, China

Ziketan Town is a farming town in Xinghai County of Hainan Tibetan Autonomous Prefecture, Qinghai province, People's Republic of China. Ziketan town covers approximately 3,000 square kilometres (1,158 sq mi) and has a population of 10,000.

1924 Los Angeles pneumonic plague outbreak

The 1924 Los Angeles pneumonic plague outbreak began October 30, 1924, and was declared fully contained on November 13, 1924. It represented the first time plague had emerged in Southern California; plague outbreaks had previously arisen in San Francisco and Oakland. The Los Angeles outbreak began on October 30, lasted two weeks, and killed 30 people. Public health officials credited the lessons learned from the San Francisco outbreak coupled with swiftly implemented measures, including hospitalization of the sick and all their contacts, a neighborhood quarantine, and a large-scale rat eradication program, with saving lives.

Legionnaires disease legionellosis that is characterized by severe form of infection producing pneumonia. Symptoms include fever, chills, and cough.

Legionnaires' disease, also known as legionellosis, is a form of atypical pneumonia caused by any type of Legionella bacteria. Signs and symptoms include cough, shortness of breath, high fever, muscle pains, and headaches. Nausea, vomiting, and diarrhea may also occur. This often begins 2–10 days after exposure.

21st century Madagascar plague outbreaks Outbreaks of plague in Madagascar during the 21st century

Madagascar has experienced two outbreaks of bubonic and pneumonic plague in the 21st century. In 2014, 40 died, and in 2017, 221 died.

Epidemiology of plague

Globally about 600 cases of plague are reported a year. In 2017 the countries with the most cases include the Democratic Republic of the Congo, Madagascar, and Peru.


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