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Pneumonic plague is a severe
lung infection Lower respiratory tract infection (LRTI) is a term often used as a synonym for pneumonia but can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, co ...
caused by the
bacterium Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
''
Yersinia pestis ''Yersinia pestis'' (''Y. pestis''; formerly '' Pasteurella pestis'') is a gram-negative, non-motile, coccobacillus bacterium without spores that is related to both ''Yersinia pseudotuberculosis'' and ''Yersinia enterocolitica''. It is a facult ...
''. Symptoms include
fever Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
, headache,
shortness of breath Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing disc ...
,
chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...
, and coughing. They typically start about three to seven days after exposure. It is one of three forms of
plague Plague or The Plague may refer to: Agriculture, fauna, and medicine *Plague (disease), a disease caused by ''Yersinia pestis'' * An epidemic of infectious disease (medical or agricultural) * A pandemic caused by such a disease * A swarm of pes ...
, the other two being
septicemic plague Septicemic plague is one of the three forms of plague, and is caused by '' Yersinia pestis'', a gram-negative species of bacterium. Septicemic plague is a systemic disease involving infection of the blood, and is most commonly spread by bites fro ...
and
bubonic plague Bubonic plague is one of three types of plague caused by the plague bacterium (''Yersinia pestis''). One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting, as well a ...
. The pneumonic form may occur following an initial bubonic or septicemic plague infection. It may also result from breathing in
airborne Airborne or Airborn may refer to: Arts, entertainment, and media Films * ''Airborne'' (1962 film), a 1962 American film directed by James Landis * ''Airborne'' (1993 film), a comedy–drama film * ''Airborne'' (1998 film), an action film sta ...
droplets from another person or animal infected with pneumonic plague. 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 A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...
, and in septicemic plague within the blood. Diagnosis is by testing the blood, sputum, or fluid from a lymph node. While
vaccine A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifie ...
s are being developed, in most countries they are not yet commercially available. Prevention is by avoiding contact with infected rodents, people, or cats. It is recommended that those infected be isolated from others. Treatment of pneumonic plague is with
antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
s. Plague is present among rodents in Africa, the Americas, and Asia. Pneumonic plague is more serious and less common than bubonic plague. The total reported number of cases of all types of plague in 2013 was 783. Left untreated, pneumonic plague is nearly always fatal. Some hypothesize that the pneumonic version of the plague was mainly responsible for the
Black Death The Black Death (also known as the Pestilence, the Great Mortality or the Plague) was a bubonic plague pandemic occurring in Western Eurasia and North Africa from 1346 to 1353. It is the most fatal pandemic recorded in human history, causi ...
that resulted in approximately 75 - 200 million deaths in the 1300s.


Signs and symptoms

The most apparent symptom of pneumonic plague is coughing, often with
hemoptysis Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. In other words, it is the airway bleeding. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and ...
(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 Sputum is mucus that is coughed up from the lower airways (the trachea and bronchi). In medicine, sputum samples are usually used for a naked eye examination, microbiological investigation of respiratory infections and cytological investigations ...
. The pneumonia progresses for two to four days and may cause respiratory failure and
shock Shock may refer to: Common uses Collective noun *Shock, a historic commercial term for a group of 60, see English numerals#Special names * Stook, or shock of grain, stacked sheaves Healthcare * Shock (circulatory), circulatory medical emergen ...
. Patients will die without early treatment, some within 36 hours. Initial pneumonic plague symptoms can often include the following: *
Fever Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
*
Weakness Weakness is a symptom of a number of different conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, i ...
*
Headaches Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result of m ...
*
Nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...
Rapidly developing
pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity ...
with: *
Shortness of breath Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing disc ...
*
Chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...
*
Cough A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three pha ...
* Bloody or watery
sputum Sputum is mucus that is coughed up from the lower airways (the trachea and bronchi). In medicine, sputum samples are usually used for a naked eye examination, microbiological investigation of respiratory infections and cytological investigations ...
(saliva and discharge from
respiratory passages The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa. Air is breathed in through the nose to t ...
).


Causes

Pneumonic plague can be caused in two ways: primary, which results from the inhalation of aerosolized plague
bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
, or secondary, when
septicemic plague Septicemic plague is one of the three forms of plague, and is caused by '' Yersinia pestis'', a gram-negative species of bacterium. Septicemic plague is a systemic disease involving infection of the blood, and is most commonly spread by bites fro ...
spreads into
lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
tissue from the bloodstream. Pneumonic plague is ''not'' exclusively
vector-borne In epidemiology, a disease vector is any living agent that carries and transmits an infectious pathogen to another living organism; agents regarded as vectors are organisms, such as Parasitism, parasites or Microorganism, microbes. The first major ...
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 of the types of plague formerly known as the
Black Death The Black Death (also known as the Pestilence, the Great Mortality or the Plague) was a bubonic plague pandemic occurring in Western Eurasia and North Africa from 1346 to 1353. It is the most fatal pandemic recorded in human history, causi ...
.


Treatment

Pneumonic plague is a very aggressive infection requiring early treatment, which must be given within 24 hours of first symptoms to reduce the risk of death.Facts about Pneumonic Plague (Center for Disease Control, 2004)
Streptomycin Streptomycin is an antibiotic medication used to treat a number of bacterial infections, including tuberculosis, ''Mycobacterium avium'' complex, endocarditis, brucellosis, ''Burkholderia'' infection, plague, tularemia, and rat bite fever. Fo ...
,
gentamicin Gentamicin is an antibiotic used to treat several types of bacterial infections. This may include bone infections, endocarditis, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections, and sepsis among others. It is not e ...
,
tetracycline Tetracycline, sold under various brand names, is an oral antibiotic in the tetracyclines family of medications, used to treat a number of infections, including Acne vulgaris, acne, cholera, brucellosis, plague (disease), plague, malaria, and sy ...
s and
chloramphenicol Chloramphenicol is an antibiotic useful for the treatment of a number of bacterial infections. This includes use as an eye ointment to treat conjunctivitis. By mouth or by injection into a vein, it is used to treat meningitis, plague, cholera, a ...
are all able to kill the causative bacterium. 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. The mortality rate from untreated pneumonic plague approaches 100%.Plague
. (Iowa State University, 2004)


Modern outbreaks

Since 2002, the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(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.


Democratic Republic of the Congo

Two outbreaks occurred in the Democratic Republic of the Congo in 2005 and 2006. The outbreak in 2005 was only detected by looking back at blood samples.


India

In September 1994, India experienced an outbreak of plague that killed 50 and caused travel to
New Delhi New Delhi (, , ''Naī Dillī'') is the capital of India and a part of the National Capital Territory of Delhi (NCT). New Delhi is the seat of all three branches of the government of India, hosting the Rashtrapati Bhavan, Parliament House ...
by air to be suspended until the outbreak was brought under control. 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. All but two of the deaths occurred around the city of
Surat Surat is a city in the western Indian state of Gujarat. The word Surat literally means ''face'' in Gujarati and Hindi. Located on the banks of the river Tapti near its confluence with the Arabian Sea, it used to be a large seaport. It is now ...
.


China

A major outbreak of the pneumonic plague occurred in
Manchuria Manchuria is an exonym (derived from the endo demonym " Manchu") for a historical and geographic region in Northeast Asia encompassing the entirety of present-day Northeast China (Inner Manchuria) and parts of the Russian Far East (Outer Manc ...
from 1910 to 1911, in what became known as the
Manchurian plague The Manchurian plague was a pneumonic plague that occurred mainly in Manchuria in 1910–1911. It killed 60,000 people, stimulating a multinational medical response and the wearing of the first personal protective equipment (PPE). __TOC__ Histor ...
, killing around 60,000 people. The
Qing court The Qing dynasty ( ), officially the Great Qing,, was a Manchu-led imperial dynasty of China and the last orthodox dynasty in Chinese history. It emerged from the Later Jin dynasty founded by the Jianzhou Jurchens, a Tungusic-speak ...
dispatched
Wu Lien-teh Wu Lien-teh (; Goh Lean Tuck and Ng Leen Tuck in Minnan and Cantonese transliteration respectively; 10 March 1879 – 21 January 1960) was a Malayan physician renowned for his work in public health, particularly the Manchurian plague of 191 ...
, a doctor educated at
Cambridge University , mottoeng = Literal: From here, light and sacred draughts. Non literal: From this place, we gain enlightenment and precious knowledge. , established = , other_name = The Chancellor, Masters and Schola ...
, to oversee disease control and treatment efforts. He made the novel observation that the disease was transmitted by air, and developed prototypical
respirator A respirator is a device designed to protect the wearer from inhaling hazardous atmospheres including fumes, vapours, gases and particulate matter such as dusts and airborne pathogens such as viruses. There are two main categories of respir ...
s to help prevent its spread. A second, less deadly outbreak occurred in 1920–21, killing approximately 9,300 people. The
People's Republic of China China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...
has eradicated pneumonic plague from most parts of the country, but still reports occasional cases in remote
western Western may refer to: Places *Western, Nebraska, a village in the US *Western, New York, a town in the US *Western Creek, Tasmania, a locality in Australia *Western Junction, Tasmania, a locality in Australia *Western world, countries that id ...
areas, where the disease is carried by rats and the
marmot Marmots are large ground squirrels in the genus ''Marmota'', with 15 species living in Asia, Europe, and North America. These herbivores are active during the summer, when they can often be found in groups, but are not seen during the winter, w ...
s that live across the
Himalayan plateau The Tibetan Plateau (, also known as the Qinghai–Tibet Plateau or the Qing–Zang Plateau () or as the Himalayan Plateau in India, is a vast elevated plateau located at the intersection of Central Asia, Central, South Asia, South and East Asi ...
. 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. 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. In September 2008, two people in
East Tibet Kham (; ) is one of the three traditional Tibetan regions, the others being Amdo in the northeast, and Ü-Tsang in central Tibet. The original residents of Kham are called Khampas (), and were governed locally by chieftains and monasteries. Kham ...
died of pneumonic plague. An outbreak of the disease in China began in August 2009 in
Ziketan Town Ziketan Town ( Tibetan: རྩི་ཀོང་ཐང་, 子科滩镇) is a farming town in Xinghai County of Hainan Tibetan Autonomous Prefecture, Qinghai province, People's Republic of China. Ziketan town covers approximately and has a popul ...
located in
Qinghai Province Qinghai (; alternately romanized as Tsinghai, Ch'inghai), also known as Kokonor, is a landlocked province in the northwest of the People's Republic of China. It is the fourth largest province of China by area and has the third smallest pop ...
. The town was sealed off and several people died as a result of the disease. According to spokesperson Vivian Tan of the WHO office in
Beijing } Beijing ( ; ; ), alternatively romanized as Peking ( ), is the capital of the People's Republic of China. It is the center of power and development of the country. Beijing is the world's most populous national capital city, with over 21 ...
, "In cases like this n 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." In September 2010, five cases of pneumonic plague were reported in Tibet. In July 2014, Chinese media reported one case found in Gansu. On 12 November 2019, It was announced that two people from the Chinese province of
Inner Mongolia Inner Mongolia, officially the Inner Mongolia Autonomous Region, is an autonomous region of the People's Republic of China. Its border includes most of the length of China's border with the country of Mongolia. Inner Mongolia also accounts for a ...
were diagnosed with pneumonic plague. They received treatment in
Chaoyang District, Beijing Chaoyang District () is a core district of Beijing. It borders the districts of Shunyi to the northeast, Tongzhou to the east and southeast, Daxing to the south, Fengtai to the southwest, Dongcheng, Xicheng and Haidian to the west, and ...
, and authorities implemented preventative control measures. Later in November, a third case of plague was confirmed. A 55-year-old man was diagnosed with
bubonic plague Bubonic plague is one of three types of plague caused by the plague bacterium (''Yersinia pestis''). One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting, as well a ...
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. 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.


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 Ascope is a province in the La Libertad Region, Peru. It is bordered by the Trujillo Province on the south; the Pacasmayo Province on the north; the Cajamarcan province of Contumazá and the Otuzco and Gran Chimú provinces on the east; and ...
, located about 325 miles (520 km) northwest of
Lima Lima ( ; ), originally founded as Ciudad de Los Reyes (City of The Kings) is the capital and the largest city of Peru. It is located in the valleys of the Chillón River, Chillón, Rímac River, Rímac and Lurín Rivers, in the desert zone of t ...
, not far from the popular Chicama beach. Most of the infections in Peru were bubonic plague, with four cases of pneumonic plague. The first recorded plague outbreak in Peru was in 1903. Prior to the above case, the last known outbreak was in 1994, killing 35 people.


Madagascar

In November 2013, an outbreak of plague occurred in the
Africa Africa is the world's second-largest and second-most populous continent, after Asia in both cases. At about 30.3 million km2 (11.7 million square miles) including adjacent islands, it covers 6% of Earth's total surface area ...
n island nation of
Madagascar Madagascar (; mg, Madagasikara, ), officially the Republic of Madagascar ( mg, Repoblikan'i Madagasikara, links=no, ; french: République de Madagascar), is an island country in the Indian Ocean, approximately off the coast of East Africa ...
. As of 16 December, at least 89 people were infected, with 39 deaths with at least two cases involving pneumonic plague. However, as many as 90% of cases were later reported to have involved pneumonic plague. 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. The diagnosis was confirmed by the Institut Pasteur de Madagascar by 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 with 474 pneumonic, 156 bubonic and one septicemic. The remainder were not classified. At least 74 deaths have been ascribed to pneumonic plague. The outbreak officially ended on 26 November 2017 with 2,348 cases and 202 deaths officially reported.


United States

In the fall of 1924, an outbreak occurred in Los Angeles that killed 30 people. On 2 November 2007, wildlife biologist Eric York died of pneumonic plague in
Grand Canyon National Park Grand Canyon National Park, located in northwestern Arizona, is the 15th site in the United States to have been named as a national park. The park's central feature is the Grand Canyon, a gorge of the Colorado River, which is often consider ...
. York was exposed to the bacteria while conducting a
necropsy An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any di ...
on a
cougar The cougar (''Puma concolor'') is a large Felidae, cat native to the Americas. Its Species distribution, range spans from the Canadian Yukon to the southern Andes in South America and is the most widespread of any large wild terrestrial mamm ...
carcass. 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 10 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 An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any di ...
revealed that the disease was the cause. Three additional pneumonic plague cases were confirmed in Colorado before the outbreak ended.Basak, Sonali; Oldham, Jennifer
Four Cases of Life-Threatening Plague Found in Colorado
, ''Bloomberg'', 19 July 2014. Accessed 4 November 2014.


References


External links

*
Frequently Asked Questions , Plague , CDC
Centers for Disease Control and Prevention. {{DEFAULTSORT:Pneumonic Plague Insect-borne diseases Plague (disease) Zoonotic bacterial diseases Wikipedia medicine articles ready to translate Wikipedia emergency medicine articles ready to translate