Epidemiology, microbiology and pathogenesis of plague (Yersinia pestis infection)
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Jason Stout, MD
Jason Stout, MD
- Associate Professor of Medicine
- Duke University Medical Center
The genus Yersinia includes 11 species, 3 of which are important human pathogens: Yersinia pestis, Yersinia enterocolitica, and Yersinia pseudotuberculosis. The yersinioses are zoonotic infections of domestic and wild animals; humans are considered incidental hosts that do not contribute to the natural disease cycle.
Y. pestis causes plague and is transmitted by fleas. The most common clinical manifestation is acute febrile lymphadenitis, called bubonic plague. Less common forms include septicemia, pneumonia, pharyngeal and meningeal plague.
The epidemiology, microbiology and pathogenesis of Y. pestis will be reviewed here. The clinical manifestations, diagnosis, and treatment of Y. pestis are discussed separately. (See "Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection)".)
Issues related to other Yersinia species are discussed separately. (See "Epidemiology of yersiniosis" and "Microbiology and pathogenesis of Yersinia infections" and "Clinical manifestations and diagnosis of Yersinia infections" and "Treatment and prevention of Yersinia enterocolitica and Yersinia pseudotuberculosis infection".)
Plague has afflicted humans for thousands of years; Y. pestis DNA has been identified in human teeth from Asia and Europe dating back between 2800 and 5000 years ago . Three major plague pandemics have been recorded in human history: in the 6th century, in the 14th century (known as the “Black Death,” which killed up to one-third of the European population or an estimated 17 to 28 million people ), and at the end of 19th century following the spread of infection from China . The plague bacillus was isolated during the third pandemic by Alexandre Yersin in 1894 . Over the ensuing 20 years, Y. pestis spread via rats on steamships to port cities on all inhabited continents, including North America. The infection spread to various species of wild rodents, becoming entrenched in rural areas of the Americas, Africa, and Asia.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Rasmussen S, Allentoft ME, Nielsen K, et al. Early divergent strains of Yersinia pestis in Eurasia 5,000 years ago. Cell 2015; 163:571.
- Drancourt M, Raoult D. Past plague. In: Paleomicrobiology: Past Human Infections, Raoult D, Drancourt M (Eds), Springer-Verlag, Berlin Heidelberg 2008. p.145.
- Prentice MB, Rahalison L. Plague. Lancet 2007; 369:1196.
- Perry RD, Fetherston JD. Yersinia pestis--etiologic agent of plague. Clin Microbiol Rev 1997; 10:35.
- Butler T. Plague gives surprises in the first decade of the 21st century in the United States and worldwide. Am J Trop Med Hyg 2013; 89:788.
- Plague around the world, 2010–2015. Wkly Epidemiol Rec 2016; 91:89.
- Human plague in 2000 and 2001. Wkly Epidemiol Rec 2003; 78:130.
- Campbell GL, Hughes JM. Plague in India: a new warning from an old nemesis. Ann Intern Med 1995; 122:151.
- Bertherat E, Bekhoucha S, Chougrani S, et al. Plague reappearance in Algeria after 50 years, 2003. Emerg Infect Dis 2007; 13:1459.
- Cabanel N, Leclercq A, Chenal-Francisque V, et al. Plague outbreak in Libya, 2009, unrelated to plague in Algeria. Emerg Infect Dis 2013; 19:230.
- World Health Organization. Fact sheet - Plague. http://www.who.int/mediacentre/factsheets/fs267/en/ (Accessed on October 10, 2017).
- World Health Organization. Disease outbreak news: Plague – Madagascar, 2 October 2017 http://www.who.int/csr/don/02-october-2017-plague-madagascar/en/ (Accessed on October 10, 2017).
- Kwit N, Nelson C, Kugeler K, et al. Human Plague - United States, 2015. MMWR Morb Mortal Wkly Rep 2015; 64:918.
- Centers for Disease Control and Prevention. Plague in the United States. www.cdc.gov/plague/maps (Accessed on March 29, 2016).
- Centers for Disease Control and Prevention (CDC). Human plague--United States, 1993-1994. MMWR Morb Mortal Wkly Rep 1994; 43:242.
- Centers for Disease Control and Prevention (CDC). Notes from the field: two cases of human plague--Oregon, 2010. MMWR Morb Mortal Wkly Rep 2011; 60:214.
- Centers for Disease Control and Prevention (CDC). Fatal laboratory-acquired infection with an attenuated Yersinia pestis Strain--Chicago, Illinois, 2009. MMWR Morb Mortal Wkly Rep 2011; 60:201.
- Wong D, Wild MA, Walburger MA, et al. Primary pneumonic plague contracted from a mountain lion carcass. Clin Infect Dis 2009; 49:e33.
- Crook LD, Tempest B. Plague. A clinical review of 27 cases. Arch Intern Med 1992; 152:1253.
- Weniger BG, Warren AJ, Forseth V, et al. Human bubonic plague transmitted by a domestic cat scratch. JAMA 1984; 251:927.
- Wang H, Cui Y, Wang Z, et al. A dog-associated primary pneumonic plague in Qinghai Province, China. Clin Infect Dis 2011; 52:185.
- Nichols MC, Ettestad PJ, Vinhatton ES, et al. Yersinia pestis infection in dogs: 62 cases (2003-2011). J Am Vet Med Assoc 2014; 244:1176.
- Runfola JK, House J, Miller L, et al. Outbreak of Human Pneumonic Plague with Dog-to-Human and Possible Human-to-Human Transmission--Colorado, June-July 2014. MMWR Morb Mortal Wkly Rep 2015; 64:429.
- Foster CL, Mould K, Reynolds P, et al. Clinical problem-solving. Sick as a dog. N Engl J Med 2015; 372:1845.
- Gage KL, Dennis DT, Orloski KA, et al. Cases of cat-associated human plague in the Western US, 1977-1998. Clin Infect Dis 2000; 30:893.
- Laudisoit A, Leirs H, Makundi RH, et al. Plague and the human flea, Tanzania. Emerg Infect Dis 2007; 13:687.
- Gage KL, Lance SE, Dennis DT, Montenieri JA. Human plague in the United States: A review of cases from 1988-1992 with comments on the likelihood of increased plague activity. Border Epidemiol Bull 1992; 19:1.
- Ayyadurai S, Sebbane F, Raoult D, Drancourt M. Body lice, yersinia pestis orientalis, and black death. Emerg Infect Dis 2010; 16:892.
- Piarroux R, Abedi AA, Shako JC, et al. Plague epidemics and lice, Democratic Republic of the Congo. Emerg Infect Dis 2013; 19:505.
- Drali R, Shako JC, Davoust B, et al. A New Clade of African Body and Head Lice Infected by Bartonella quintana and Yersinia pestis-Democratic Republic of the Congo. Am J Trop Med Hyg 2015; 93:990.
- Inglesby TV, Dennis DT, Henderson DA, et al. Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA 2000; 283:2281.
- Achtman M, Zurth K, Morelli G, et al. Yersinia pestis, the cause of plague, is a recently emerged clone of Yersinia pseudotuberculosis. Proc Natl Acad Sci U S A 1999; 96:14043.
- Achtman M, Morelli G, Zhu P, et al. Microevolution and history of the plague bacillus, Yersinia pestis. Proc Natl Acad Sci U S A 2004; 101:17837.
- Chain PS, Carniel E, Larimer FW, et al. Insights into the evolution of Yersinia pestis through whole-genome comparison with Yersinia pseudotuberculosis. Proc Natl Acad Sci U S A 2004; 101:13826.
- Zhou D, Han Y, Yang R. Molecular and physiological insights into plague transmission, virulence and etiology. Microbes Infect 2006; 8:273.
- Hinnebusch BJ. The evolution of flea-borne transmission in Yersinia pestis. Curr Issues Mol Biol 2005; 7:197.
- Zhou D, Tong Z, Song Y, et al. Genetics of metabolic variations between Yersinia pestis biovars and the proposal of a new biovar, microtus. J Bacteriol 2004; 186:5147.
- Drancourt M, Roux V, Dang LV, et al. Genotyping, Orientalis-like Yersinia pestis, and plague pandemics. Emerg Infect Dis 2004; 10:1585.
- Hinnebusch BJ, Rudolph AE, Cherepanov P, et al. Role of Yersinia murine toxin in survival of Yersinia pestis in the midgut of the flea vector. Science 2002; 296:733.
- Hinnebusch BJ, Perry RD, Schwan TG. Role of the Yersinia pestis hemin storage (hms) locus in the transmission of plague by fleas. Science 1996; 273:367.
- Eisen RJ, Dennis DT, Gage KL. The Role of Early-Phase Transmission in the Spread of Yersinia pestis. J Med Entomol 2015; 52:1183.
- Pujol C, Bliska JB. Turning Yersinia pathogenesis outside in: subversion of macrophage function by intracellular yersiniae. Clin Immunol 2005; 114:216.
- Marketon MM, DePaolo RW, DeBord KL, et al. Plague bacteria target immune cells during infection. Science 2005; 309:1739.
- Butler T. A clinical study of bubonic plague. Observations of the 1970 Vietnam epidemic with emphasis on coagulation studies, skin histology and electrocardiograms. Am J Med 1972; 53:268.
- David T. Dennis, Paul S. Mead. Yersinia Species, Including Plague. In: Principles and Pracitce of Infectious Diseases, seventh, Gerald L. Mandell, John E. Bennett, Raphael Dolin (Eds), Elsevier, Philadelphia 2010. p.2943.