Clinical manifestations, diagnosis, and treatment 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
The genus Yersinia includes 11 species, three 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 clinical features, diagnosis, and treatment of plague will be reviewed here. The epidemiology, microbiology, and pathogenesis of Y. pestis are discussed separately. (See "Epidemiology, microbiology and pathogenesis 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 is a murine zoonosis; humans are incidental hosts. Humans acquire plague via bites of rodent fleas, scratches or bites from infected domestic cats, direct handling of infected animal tissues, inhalation of respiratory secretions from infected animals, inhalation of aerosolized droplets from infected humans, consumption of contaminated food, or by laboratory exposure [1-5]. The incubation period is generally two to eight days. (See "Epidemiology, microbiology and pathogenesis of plague (Yersinia pestis infection)".)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:
- Prentice MB, Rahalison L. Plague. Lancet 2007; 369:1196.
- Centers for Disease Control and Prevention (CDC). Human plague--United States, 1993-1994. MMWR Morb Mortal Wkly Rep 1994; 43:242.
- 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.
- 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.
- Daya M, Nakamura Y. Pulmonary disease from biological agents: anthrax, plague, Q fever, and tularemia. Crit Care Clin 2005; 21:747.
- Ratsitorahina M, Chanteau S, Rahalison L, et al. Epidemiological and diagnostic aspects of the outbreak of pneumonic plague in Madagascar. Lancet 2000; 355:111.
- Campbell GL, Hughes JM. Plague in India: a new warning from an old nemesis. Ann Intern Med 1995; 122:151.
- 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.
- Welty TK, Grabman J, Kompare E, et al. Nineteen cases of plague in Arizona. A spectrum including ecthyma gangrenosum due to plague and plague in pregnancy. West J Med 1985; 142:641.
- Butler T. Yersinia infections: centennial of the discovery of the plague bacillus. Clin Infect Dis 1994; 19:655.
- Warren R, Lockman H, Barnewall R, et al. Cynomolgus macaque model for pneumonic plague. Microb Pathog 2011; 50:12.
- Wang H, Cui Y, Wang Z, et al. A dog-associated primary pneumonic plague in Qinghai Province, China. Clin Infect Dis 2011; 52:185.
- Begier EM, Asiki G, Anywaine Z, et al. Pneumonic plague cluster, Uganda, 2004. Emerg Infect Dis 2006; 12:460.
- Marshall JD Jr, Quy DV, Gibson FL. Asymptomatic pharyngeal plague infection in Vietnam. Am J Trop Med Hyg 1967; 16:175.
- Butler T, Bell WR, Nguyen-Ngoc-Linh, et al. Yersinia pestis infection in Vietnam. I. Clinical and hematologic aspects. J Infect Dis 1974; 129:Suppl:S78.
- Alsofrom DJ, Mettler FA Jr, Mann JM. Radiographic manifestations of plaque in New Mexico, 1975-1980. A review of 42 proved cases. Radiology 1981; 139:561.
- Sinyange N, Kumar R, Inambao A, et al. Outbreak of Plague in a High Malaria Endemic Region - Nyimba District, Zambia, March-May 2015. MMWR Morb Mortal Wkly Rep 2016; 65:807.
- Tourdjman M, Ibraheem M, Brett M, et al. Misidentification of Yersinia pestis by automated systems, resulting in delayed diagnoses of human plague infections--Oregon and New Mexico, 2010-2011. Clin Infect Dis 2012; 55:e58.
- Foster CL, Mould K, Reynolds P, et al. Clinical problem-solving. Sick as a dog. N Engl J Med 2015; 372:1845.
- Chanteau S, Rahalison L, Ralafiarisoa L, et al. Development and testing of a rapid diagnostic test for bubonic and pneumonic plague. Lancet 2003; 361:211.
- Loïez C, Herwegh S, Wallet F, et al. Detection of Yersinia pestis in sputum by real-time PCR. J Clin Microbiol 2003; 41:4873.
- Radnedge L, Gamez-Chin S, McCready PM, et al. Identification of nucleotide sequences for the specific and rapid detection of Yersinia pestis. Appl Environ Microbiol 2001; 67:3759.
- Seifert L, Harbeck M, Thomas A, et al. Strategy for sensitive and specific detection of Yersinia pestis in skeletons of the black death pandemic. PLoS One 2013; 8:e75742.
- Vandamm JP, Rajanna C, Sharp NJ, et al. Rapid detection and simultaneous antibiotic susceptibility analysis of Yersinia pestis directly from clinical specimens by use of reporter phage. J Clin Microbiol 2014; 52:2998.
- Wagle PM. Recent advances in the treatment of bubonic plague. Indian J Med Sci 1948; 2:489.
- MEYER KF. Modern therapy of plague. J Am Med Assoc 1950; 144:982.
- Datt Gupta AK. A short note on plague cases treated at Campbell Hospital. Ind Med Gaz 1948; 83:150.
- Butler T, Levin J, Linh NN, et al. Yersinia pestis infection in Vietnam. II. Quantiative blood cultures and detection of endotoxin in the cerebrospinal fluid of patients with meningitis. J Infect Dis 1976; 133:493.
- Boulanger LL, Ettestad P, Fogarty JD, et al. Gentamicin and tetracyclines for the treatment of human plague: review of 75 cases in new Mexico, 1985-1999. Clin Infect Dis 2004; 38:663.
- Wong JD, Barash JR, Sandfort RF, Janda JM. Susceptibilities of Yersinia pestis strains to 12 antimicrobial agents. Antimicrob Agents Chemother 2000; 44:1995.
- Bonacorsi SP, Scavizzi MR, Guiyoule A, et al. Assessment of a fluoroquinolone, three beta-lactams, two aminoglycosides, and a cycline in treatment of murine Yersinia pestis infection. Antimicrob Agents Chemother 1994; 38:481.
- Frean JA, Arntzen L, Capper T, et al. In vitro activities of 14 antibiotics against 100 human isolates of Yersinia pestis from a southern African plague focus. Antimicrob Agents Chemother 1996; 40:2646.
- Smith MD, Vinh DX, Nguyen TT, et al. In vitro antimicrobial susceptibilities of strains of Yersinia pestis. Antimicrob Agents Chemother 1995; 39:2153.
- Mwengee W, Butler T, Mgema S, et al. Treatment of plague with gentamicin or doxycycline in a randomized clinical trial in Tanzania. Clin Infect Dis 2006; 42:614.
- Layton RC, Mega W, McDonald JD, et al. Levofloxacin cures experimental pneumonic plague in African green monkeys. PLoS Negl Trop Dis 2011; 5:e959.
- Peterson JW, Moen ST, Healy D, et al. Protection Afforded by Fluoroquinolones in Animal Models of Respiratory Infections with Bacillus anthracis, Yersinia pestis, and Francisella tularensis. Open Microbiol J 2010; 4:34.
- Kuberski T, Robinson L, Schurgin A. A case of plague successfully treated with ciprofloxacin and sympathetic blockade for treatment of gangrene. Clin Infect Dis 2003; 36:521.
- Apangu T, Griffith K, Abaru J, et al. Successful Treatment of Human Plague with Oral Ciprofloxacin. Emerg Infect Dis 2017; 23.
- http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm302220.htm (Accessed on May 01, 2012).
- http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm446283.htm (Accessed on May 11, 2015).
- MCCRUMB FR Jr, MERCIER S, ROBIC J, et al. Chloramphenicol and terramycin in the treatment of pneumonic plague. Am J Med 1953; 14:284.
- Nguyen-Van-Ai, Nguyen-Duc-Hanh, Pham-Van-Dien, Nguyen-Van-Le . Letter: Co-trimoxazole in bubonic plague. Br Med J 1973; 4:108.
- Urich SK, Chalcraft L, Schriefer ME, et al. Lack of antimicrobial resistance in Yersinia pestis isolates from 17 countries in the Americas, Africa, and Asia. Antimicrob Agents Chemother 2012; 56:555.
- Galimand M, Guiyoule A, Gerbaud G, et al. Multidrug resistance in Yersinia pestis mediated by a transferable plasmid. N Engl J Med 1997; 337:677.
- Guiyoule A, Gerbaud G, Buchrieser C, et al. Transferable plasmid-mediated resistance to streptomycin in a clinical isolate of Yersinia pestis. Emerg Infect Dis 2001; 7:43.
- Cavanaugh DC, Elisberg BL, Llewellyn CH, et al. Plague immunization. V. Indirect evidence for the efficacy of plague vaccine. J Infect Dis 1974; 129:Suppl:S37.
- Galimand M, Carniel E, Courvalin P. Resistance of Yersinia pestis to antimicrobial agents. Antimicrob Agents Chemother 2006; 50:3233.
- Morris SR. Development of a recombinant vaccine against aerosolized plague. Vaccine 2007; 25:3115.
- Demeure CE, Derbise A, Carniel E. Oral vaccination against plague using Yersinia pseudotuberculosis. Chem Biol Interact 2017; 267:89.