Plague

Plague is an illness you get from the bacteria Yersinia pestis (Y. pestis). It usually spreads through flea bites, but you can also get it from other people and animals.

There have been severe outbreaks of plague throughout history. It still exists today, but it’s very rare. Worldwide, 1,000 to 2,000 people are diagnosed with plague every year. Only a few cases are reported in the U.S. each year.

Types

The type of plague you have depends on where in your body you’re infected with Y. pestis:

• Bubonic plague: This is a pestis infection that travels to your lymph nodes from a flea bite. It makes large, swollen lymph nodes called buboes. Bubonic plague is the most common form of plague. It’s also the most survivable.
• Septicemic plague: This refers to a pestis infection in your blood. You can get it from a flea bite or have it spread to your blood from other parts of your body. It destroys your tissues, leading to organ failure.
• Pneumonic plague: This is a pestis infection in your lungs. You can get it from other people, or it can spread to your lungs from other parts of your body. It causes severe pneumonia and is the most dangerous type of plague. It’s less common than septicemic and bubonic infections.
• Pharyngeal plague: This plague is a pestis infection in your throat. It’s a rare type of infection you get from eating infected meat.

Symptoms of plague

Some plague symptoms depend on the kind of plague you have. Others happen in all types. Symptoms include:

• Fever
• Chills
• Headaches and body aches
• Weakness and fatigue
• Dizziness
• Nausea, vomiting and diarrhea
• Painful, swollen lymph nodes (bubonic plague)
• Abdominal pain and bleeding from your nose, your mouth or under your skin (septicemic plague)
• Shortness of breath, chest pain, cough and bloody or watery mucus (pneumonic plague)
• Sore throat (pharyngeal plague)

Plague causes

Yersinia pestis (Y. pestis) bacteria cause plague. Rats, other mammals and fleas can carry Y. pestis. It can spread to people from animals and other people.

You can get plague:

• From flea bites: Fleas bite rats or other animals infected with pestis, then bite you.
• Contact with an infected animal: You can get infected with Y. pestis by touching the body fluids or tissues of an infected animal.
• Eating infected meat: You can get pharyngeal plague by eating uncooked or undercooked meat from an infected animal.
• From another person: If someone has Y. pestis in their lungs (pneumonic plague), you can get infected if they cough or sneeze on you.

Plague can also move through your bloodstream to different parts of your body (secondary infection).

Risk factors

Plague mostly affects people living in a few countries in Africa. It’s most common in Madagascar and the Democratic Republic of Congo. Cases are also reported in the Americas and Asia every year.

In the U.S., you’re more likely to get plague in rural areas of western states. You’re at a higher risk if you work with animals in an area where plague is found.

What animals carry plague?

Most people think of rats as the only carriers of plague. But many animals carry and spread the disease. Which animals are more likely to have plague depends on where you live. Plague can affect:

• Rodents (including rats, mice, prairie dogs, gerbils and guinea pigs)
• Other small mammals
• Dogs and cats
• Deer
• Camels

Complications

Many complications of plague happen quickly and are life-threatening. These include:

• Inflammation of the lining of your brain and spinal cord (meningitis)
• Tissue death and loss of limbs from gangrene
• Respiratory failure
• Organ failure

How doctors diagnose plague

To diagnose plague, your healthcare provider will take a sample of your blood, mucus from your lungs or throat, or fluid from a lymph node. They’ll send your sample to a lab to look for signs of Y. pestis.

Make sure to tell your provider if you:

• Live in or have recently visited an area where there are plague infections
• Have been bitten by fleas
• Have handled animals that could be infected
• Have one or more painful lymph nodes

How is plague treated?

Healthcare providers treat plague with antibiotics. They’ll give you medication either through a vein (IV) or in a pill. Depending on your symptoms and risk, you may start antibiotics even before test results come back. Your provider might also give you extra oxygen or other treatments to manage your symptoms.

You need immediate treatment if you have plague. You have the best chance of getting better if you start treatment within 24 hours of noticing symptoms.

Recovery time

You’ll probably feel better within a week or two of starting treatment. Take any medications as prescribed, even if you feel better. Buboes from bubonic plague might take a few weeks to go away. Ask your provider how long you should avoid other people to prevent spreading the bacteria.

When should I see my healthcare provider?

Contact your healthcare provider for immediate medical attention if you:

• Think you’ve been exposed to plague
• Live in or have recently traveled to areas where plague exists and have symptoms

Can you recover from the plague?

Yes, you can recover from plague with antibiotics. But you need to be treated right away. The kind of plague you have makes a difference, too. Pneumonic plague is almost always fatal without treatment.

Can plague be prevented?

You can reduce your risk of plague by avoiding flea bites and being careful around animals that could be infected. Specific strategies include:

• Clear piles of brush, wood, trash or other places where wild animals might make a home. Don’t leave pet food out or feed wild animals.
• Wear bug spray with DEET.
• Wear gloves if you have to handle animals that could be infected. This includes living and dead animals.
• Keep your pets safe. Don’t let them roam free outside, especially if you live in an area where plague is more common. Ask your pet’s veterinarian how to prevent fleas.
• If you think you’ve been exposed to plague, ask your healthcare provider whether you should take antibiotics to prevent getting sick.

What is the “Black Death”?

What people sometimes call “the Black Death” was a plague outbreak that killed millions of people in Europe, Asia and North Africa in the mid-1300s. Hunger and poor sanitation made people vulnerable to sickness, and it spread to different countries through trade routes. It’s usually what people mean when they talk about “the plague.”