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Epidemiology, microbiology and pathogenesis of plague (Yersinia pestis infection)

Daniel J Sexton, MD
Jason Stout, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


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 [1]. 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 [2]), and at the end of 19th century following the spread of infection from China [3]. The plague bacillus was isolated during the third pandemic by Alexandre Yersin in 1894 [4]. 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.

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Literature review current through: Nov 2017. | This topic last updated: Oct 17, 2017.
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