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

The pneumonic form may occur following an initial bubonic or septicemic plague infection.[3] It also may result from breathing in airborne droplets from another person or animal infected with pneumonic plague.[1] The factor that differs among the three 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]

While vaccines are being developed, in most countries they are not yet commercially available.[1][3] Plague is present among rodents in Africa, the Americas, and Asia.[3] The total reported number of cases of all types of plague in 2013 was 783.[2]

Pneumonic plague can be prevented by avoiding contact with infected people and animals, and by the use of correctly fitted N95 masks.[1][3] It is recommended that those infected be isolated from others.[2] Treatment of pneumonic plague consists of antibiotics.[1]

Pneumonic plague is more serious and less common than bubonic plague.[1] Left untreated, pneumonic plague is almost always fatal.[6]

Some hypothesize that the pneumonic version of the plague was mainly responsible for the Black Death that resulted in approximately 25–50 million deaths in Europe in the 1300s.[2][7]

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.[8]

The pneumonia associated with pneumonic plague progresses for two to four days and may cause respiratory failure and shock. Patients will die without early treatment, some within 36 hours.[citation needed]

Initial pneumonic plague symptoms often may include the following:[citation needed]

Rapidly developing pneumonia with:[citation needed]

Causes

Pneumonic plague may be caused in two ways: primarily through transmission via the inhalation of aerosolized plague bacteria, or secondarily when infection by septicemic plague spreads into lung tissue from the bloodstream.

Pneumonic plague may 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 of the types of plague formerly known as the Black Death.[9] Its transmission is different from bubonic plague that is exclusively vector-borne.

Treatment

Pneumonic plague is a very aggressive infection requiring early treatment that must be given within 24 hours of first symptoms to reduce the risk of death.[8] Streptomycin, gentamicin, tetracyclines, and chloramphenicol are the types of antibiotics used to treat the causative bacterium.

Antibiotic treatment for seven days will protect people who have had direct, close contact with infected patients. Wearing a correctly fitted N95 mask may also protect against infection.[8] Antibiotic treatment may worsen patient conditions or cause death in cases of Y. pestis designs that had been combined with other toxins or viruses, as the latter would be released upon cell lysis; such designs had been created at Biopreparat in the 1980s.[10]

The mortality rate from untreated pneumonic plague approaches 100%, although victims of the Black Death who vomited blood occasionally survived, such as the chronicler Marcha di Marco Battagli.[11][12]

Modern outbreaks

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

Democratic Republic of the Congo

Two outbreaks occurred in the Democratic Republic of the Congo in 2005 and 2006.[13] The outbreak in 2005 was only detected by examination of blood samples after the outbreak became recognized.[13] The total death toll was 111.

India

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.[14] The outbreak was feared to be much worse because the plague superficially resembles other common diseases such as influenza and bronchitis; more than 200 people who had been quarantined were released when they did not test positive for the plague.[15] All but three of the deaths occurred around the city of Surat.[16]

China

A major outbreak of the pneumonic plague occurred in Manchuria from 1910 to 1911, in what became known as the Manchurian plague, killing approximately 60,000 people.[17] The Qing court dispatched Wu Lien-teh, a physician educated at Cambridge University, to oversee disease control and treatment efforts. He made the novel observation that the disease was transmitted by air and he developed prototypical respirators to help prevent its spread.[18] A second, less deadly outbreak occurred in 1920–21, killing approximately 9,300 people.[17]

The People's Republic of China has eradicated 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 living across the Himalayan plateau. Outbreaks may 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.[19]

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 to 254 in 2000.[20] In September 2008, two people in East Tibet died of pneumonic plague.[21]

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.[19][22] 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."[23]

In September 2010, five cases of pneumonic plague were reported in Tibet.[24]

In July 2014, Chinese media reported one case found in Gansu.[25]

On 12 November 2019, it was announced that two people from the Chinese province of Inner Mongolia were diagnosed with pneumonic plague. They received treatment in Chaoyang District, Beijing and authorities implemented preventative control measures.[26] Later in November, a third case of plague was confirmed. A 55-year-old man was diagnosed with bubonic plague after eating wild rabbit in Inner Mongolia. The region's health commission says it has no evidence to suggest that this case is linked to the previous two.[27] By the end of November, a fourth case was confirmed. Chinese health authorities reported a fresh case of bubonic plague in the country's northern Inner Mongolia region, bringing the total number of reported plague cases originating from Inner Mongolia to four.[28]

Peru

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 the popular Chicama beach. Most of the infections in Peru were bubonic plague, with four cases of pneumonic plague.[29]

The first recorded plague outbreak in Peru was in 1903. Before the above case, the last known outbreak was in 1994, killing 35 people.[30]

Madagascar

Medical team working together during a plague outbreak in Madagascar (October 2017)

In November 2013, an outbreak of plague occurred in the African island nation of Madagascar.[31] As of 16 December, at least 89 people were infected and 39 deaths occurred.[32] Initially, at least two cases were reported as pneumonic plague, however, as many as 90% of cases were later reported to have involved pneumonic plague.[33]

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.[34] The diagnosis was confirmed by the Institut Pasteur de Madagascar using a polymerase chain reaction test, while field health workers used a Rapid Diagnostic Test. The WHO and Institut Pasteur de Madagascar 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 that included 474 pneumonic, 156 bubonic, and one septicemic. The remainder were not classified. At least 74 deaths have been ascribed to pneumonic plague.[35]

The outbreak officially ended on 26 November 2017 with 2,348 cases and 202 deaths officially reported.[36]

Russia

In early October 2026, 28-year-old laboratory technician Daria Shipilova died in the hospital after possibly contracting the pneumonic plague while at the Irkutsk Anti-Plague Research Institute of Siberia and the Far East in Shelekhov.[37][38] The hospital was quarantined, and at least 197 people were put under observation.[38] Several other local hospitals, including the children's hospital, began enforcing a three-week quarantine,[39] and public events in the city were cancelled.[38]

United States

In the fall of 1924, an outbreak occurred in Los Angeles[40] that killed 30 people.

On 2 November 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 cougar carcass.[41]

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 pneumonic plague was the cause.[42][43] Three additional pneumonic plague cases were confirmed in Colorado before the outbreak ended.[44]

A person near Flagstaff, Arizona, died of pneumonic plague in July 2025.[45]

References

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  2. 1 2 3 4 5 "Plague". World Health Organization. September 2016. Archived from the original on 24 April 2015. Retrieved 14 March 2017.
  3. 1 2 3 4 5 6 7 8 "Plague". www.who.int. Archived from the original on 19 March 2017. Retrieved 14 March 2017.
  4. ↑ "Plague" (PDF). www.cfsph.iastate.edu. Archived from the original (PDF) on 31 January 2017.
  5. ↑ "Human Plague — United States, 2015". www.cdc.gov. 28 August 2015. Archived from the original on 11 February 2025. Retrieved 14 March 2025.
  6. ↑ "Plague" (PDF). Archived from the original (PDF) on 17 September 2004.
  7. ↑ McCoy, Terrence (31 March 2014). "Everything you know about the Black Death is wrong". Washington Post. The Washington Post. Archived from the original on 27 August 2016. Retrieved 14 March 2017.
  8. 1 2 3 Facts about Pneumonic Plague (Center for Disease Control, 2004) Archived 2 August 2013 at the Wayback Machine
  9. ↑ Benedictow, Ole Jørgen (2004). The Black Death, 1346–1353: The Complete History. Boydell & Brewer. pp. 27–28. ISBN 0-85115-943-5.
  10. ↑ Russian and American use of Yersinia pestis as a Biological Weapon . (Montana State University, 2005)
  11. ↑ Plague Archived 31 January 2017 at the Wayback Machine. (Iowa State University, 2004)
  12. ↑ Samuel Cohn's The Black Death Transformed: Disease and Culture in Early Renaissance Europe, pg 93.
  13. 1 2 Bertherat, Eric; Thullier, Philippe; Shako, Jean Christophe; England, Kathleen; Koné, Mamadou-Lamine; Arntzen, Lorraine; Tomaso, Herbert; Koyange, Louis; Formenty, Pierre; Ekwanzala, Florent; Crestani, Rosa; Ciglenecki, Isa; Rahalison, Lila (2011). "Lessons Learned about Pneumonic Plague Diagnosis from 2 Outbreaks, Democratic Republic of the Congo". Emerging Infectious Diseases. 17 (5): 778–84. doi:10.3201/eid1705.100029. PMC 3321750. PMID 21529384.
  14. ↑ Plague Fears Cancel Flights. The Daily Gleaner, 1 October 1994.
  15. ↑ Plague Fears Beginning to Recede. The Daily Gleaner, 2 October 1994.
  16. ↑ Mavalankar, D. V. (October 1995). "Indian 'plague' epidemic: unanswered questions and key lessons". Journal of the Royal Society of Medicine. 88 (10): 547–551. PMC 1295353. PMID 8537942.
  17. 1 2 Welford, Mark R.; Bossak, Brian H.; Carter, Dee A. (22 December 2009). "Validation of Inverse Seasonal Peak Mortality in Medieval Plagues, Including the Black Death, in Comparison to Modern Yersinia pestis-Variant Diseases". PLOS ONE. 4 (12) e8401. Bibcode:2009PLoSO...4.8401W. doi:10.1371/journal.pone.0008401. PMC 2791870. PMID 20027294.
  18. ↑ Wilson, Mark (24 March 2020). "The untold origin story of the N95 mask". Fast Company.
  19. 1 2 "China disinfects town where plague killed 3rd man". Associated Press. 4 August 2009. Archived from the original on 8 August 2009.
  20. ↑ Macartney, Jane (3 August 2009). Entire town in quarantine after two die from pneumonic plague in China Archived 29 April 2011 at the Wayback Machine. The Times (London).
  21. ↑ "Canada Tibet Committee | Library | WTN". www.tibet.ca. Archived from the original on 14 November 2009.
  22. ↑ "4th plague patient near death in NW China province". Xinhua. 5 August 2009. Archived from the original on 8 August 2009.
  23. ↑ Alert over China plague outbreak Archived 3 August 2009 at the Wayback Machine. Al Jazeera. 3 August 2009.
  24. ↑ Dawa, W; Pan, W. J.; Gu, X. Y.; Zhang, S. Q.; Dawa, C; Yi, X; Ciwang, Z; Wang, Y; Li, S. Y.; Jiang, R. M. (2011). "Clinical features, diagnosis and treatment of 5 cases of primary pneumonic plague in Tibet in 2010". Zhonghua jie he he hu xi za zhi. 34 (6): 404–08. PMID 21781509.
  25. ↑ "151 quarantined in Gansu after plague death – China". Chinadaily.com.cn. 18 July 2014. Archived from the original on 18 July 2014. Retrieved 30 January 2018.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  26. ↑ Yeung, Jessie. "Two people got the plague in China. Why is it still a thing?". CNN. Retrieved 14 November 2019.
  27. ↑ Samuel, Sigal (14 November 2019). "We never really got rid of the plague. 3 people in China just caught it". Vox. Retrieved 25 July 2020.
  28. ↑ "China reports fourth case of plague this month". Reuters. 28 November 2019. Retrieved 25 July 2020 – via www.reuters.com.
  29. ↑ Peru suffers deadly outbreak of bubonic and pneumonic plague Archived 4 February 2013 at the Wayback Machine, The Telegraph, 3 August 2010. Accessed 4 November 2014.
  30. ↑ "Peru's health minister says plague outbreak has killed teenager, infected at least 31 people". Archived from the original on 17 August 2010. Retrieved 3 August 2010.
  31. ↑ "Plague kills 39 in Madagascar". www.theaustralian.com.au. 12 December 2013.
  32. ↑ "Madagascar hit by 'deadlier plague'". BBC News. 11 December 2013. Archived from the original on 16 December 2013. Retrieved 16 December 2013.
  33. ↑ "Bubonic plague 'worse than Black Death' kills 39 in Madagascar" Archived 16 December 2013 at the Wayback Machine, South China Morning Post, 12 December 2013. Accessed 4 November 2014.
  34. ↑ "Plague – Madagascar Disease outbreak news". Archived from the original on 2 October 2017. Retrieved 5 October 2017.
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  37. ↑ Lister, Tim; Vlasova, Svitlana; Harvey, Lex; Chernova, Anna (5 October 2026). "Researcher at Russian plague laboratory dies of 'unknown' infection". CNN. Retrieved 5 October 2026.
  38. 1 2 3 "Nearly 200 People Under Observation After Irkutsk Lab Worker Dies From Plague". The Moscow Times. 2 October 2026. Retrieved 5 October 2026.
  39. ↑ Fenbert, Abbey; Hourani, Linda (4 October 2026). "Plague death triggers quarantine, mask mandates in Russia's Irkutsk region in Siberia". Kyiv Independent. Retrieved 5 October 2026.
  40. ↑ Donnelly, Thomas M.; Bergin, Ingrid; Ihrig, Melanie (2015). "Biology and Diseases of Other Rodents". Laboratory Animal Medicine. pp. 285–349. doi:10.1016/B978-0-12-409527-4.00007-9. ISBN 978-0-12-409527-4.
  41. ↑ "Plague emerges in Grand Canyon, kills biologist". USAToday.com. Archived from the original on 19 April 2012.
  42. ↑ Coffman, Keith. Man diagnosed with rare pneumonic plague in Colorado, Reuters (9 July 2014).
  43. ↑ Kaplan, Sarah. "A Colorado pit bull infected humans with the plague". Washington Post. ISSN 0190-8286. Retrieved 21 September 2020.
  44. ↑ Basak, Sonali; Oldham, Jennifer. Four Cases of Life-Threatening Plague Found in Colorado Archived 14 January 2015 at the Wayback Machine, Bloomberg, 19 July 2014. Accessed 4 November 2014.
  45. ↑ "Plague kills Arizona resident, marking first recorded death since 2007, health officials say". CBS News. 12 July 2025. Retrieved 12 July 2025.
source: https://en.wikipedia.org/wiki/Pneumonic_plague