Plague

Flea

Flea bite - close-up

Antibodies

Plague

Definition:

An infection caused by the organism Yersinia pestis which occurs in wild rodents and is transmitted to humans.

Alternative Names:

Bubonic plague; Pneumonic plague; Septicemic plague

Causes, incidence, and risk factors:

Plague is transmitted among rodents and to humans by flea bite or ingestion of the feces of fleas. It can also be transmitted human to human when a plague victim develops pneumonia and spreads infected droplets by coughing. An epidemic may be started this way.

Endemic areas in the U.S. are California, Utah, Arizona, Nevada, and New Mexico. Two types of plague, bubonic and pneumonic, can occur. The incubation period is 2 to 10 days but may be as short as a few hours for pneumonic plague.

Risk factors include a recent flea bite; and occupational or environmental exposure to rodents (especially rabbits, squirrels, or prairie dogs; or scratches or bites from infected domestic cats). The incidence of the disease is rare.

Symptoms:

BUBONIC PLAGUE

Sudden onset of high fever
Chills
General discomfort, uneasiness, or ill feeling (malaise)
Muscular pains
Severe headache
Smooth, oval, reddened, painful swellings of swollen lymph glands called buboes in the groin, armpits, neck, or elsewhere in the body. Pain may occur in the area before the swelling; the most common area is in the groin
Seizures

PNEUMONIC PLAGUE

SEPTICEMIC PLAGUE

Fever
Extreme illness
Nausea, vomiting, diarrhea and abdominal pain
Low blood pressure
Blood clotting problems
Failure of several or all organ systems

Signs and tests:

These tests may indicate a plague infection:

Treatment:

Immediate treatment with antibiotics such as streptomycin, chloramphenicol, or tetracycline is indicated. Oxygen, intravenous fluids, and respiratory support are additional treatments. Patients with pneumonic plague are strictly isolated from other patients. People who have had contact with anyone infected by pneumonic plague are observed closely and are given antibiotics as a preventive measure.

Note: Oral tetracycline is usually not prescribed for children until after all the permanent teeth have erupted. It can permanently discolor teeth that are still forming.

Expectations (prognosis):

Half of bubonic plague victims die if not treated, and almost all victims of pneumonic plague die if not treated. Treatment reduces the death rate to 5%.

Complications:

Some complications include septicemia (blood poisoning).

Calling your health care provider:

Call your health care provider if symptoms develop after exposure to fleas or rodents, especially if you live or have visited in an area where plague occurs frequently (endemic areas). Endemic areas in the U.S. are California, Arizona, Utah, Nevada, and New Mexico.

Prevention:

Rat control and surveillance of 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.

Review Date: 7/16/2001
Reviewed By: Camille Kotton, M.D., Infectious Diseases Division, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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