Plague is an infection caused by Yersinia pestis; pneumonic plague is the form that affects the lungs. Plague can also be bubonic or septicemic. Pneumonic plague is especially urgent because it can cause rapidly worsening pneumonia and can spread between people through infectious respiratory droplets during close contact. Anyone who may have plague needs immediate professional medical care.
What is the difference between plague and pneumonic plague?
They are not separate diseases or different bacteria. Plague is the infection; bubonic, septicemic, and pneumonic describe its clinical forms. Pneumonic plague involves the lungs. It may begin when infection reaches the lungs from another form of plague, or it may start after a person inhales infectious droplets.
| Form | Main symptoms and affected area | Typical exposure or development | Person-to-person spread |
|---|---|---|---|
| Bubonic | Fever, headache, chills, weakness, and one or more swollen, painful lymph nodes called buboes. | Usually follows an infected flea bite. CDC lists an incubation period of 2–8 days. CDC clinical signs and symptoms | Not described as spreading directly between people. |
| Septicemic | Fever, chills, extreme weakness, abdominal pain, shock, and sometimes bleeding into the skin or organs. | Can occur first or develop from untreated bubonic plague; exposure may follow an infected flea bite or contact with an infected animal. CDC clinical signs and symptoms | Not described as spreading directly between people. |
| Pneumonic | Fever, headache, weakness, and rapidly developing pneumonia, often with shortness of breath, chest pain, cough, and sometimes bloody or watery mucus. | Can be primary after inhaling infectious droplets, or secondary when infection reaches the lungs from untreated bubonic or septicemic plague. CDC clinical signs and symptoms | Yes. This is the only form that can spread from person to person, through infectious respiratory droplets. |
What are the symptoms of pneumonic plague?
Pneumonic plague can cause fever, headache, and weakness followed by quickly developing pneumonia. Warning signs include cough, chest pain, and shortness of breath; mucus may be bloody or watery. Because the illness can progress rapidly, do not wait to see whether symptoms improve if plague is a possibility.
Symptoms alone cannot establish that someone has plague. A clinician must assess the illness and arrange appropriate testing. If symptoms follow a possible exposure, seek urgent medical care and tell clinicians about the exposure.
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How does plague spread?
People most often acquire plague through bites from infected rodent fleas. Handling infected animal tissue or body fluids is another route. Pneumonic plague can also spread when someone inhales infectious droplets coughed by a person or animal with pneumonic plague, usually during direct, close contact. CDC describes respiratory droplets as the only way plague spreads between people: CDC information on causes and spread.
CDC’s 2021 review estimated a basic reproductive number (R₀) of 1.18 for pneumonic plague in the United States, using surveillance data from 1900–2009. This is a historical population-level estimate based on those data, not a current forecast of an individual’s risk: CDC Emerging Infectious Diseases review (2021).
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Where does plague occur?
CDC says plague occurs naturally in parts of the western United States and in certain regions of Africa and Asia. CDC also reports that human-to-human spread has not been documented in the United States since 1924; rare pneumonic plague cases have followed exposure to sick cats. These statements describe the geography and documented U.S. history cited by CDC, not an absence of plague elsewhere: CDC information on causes and spread and CDC overview of plague.
How is plague diagnosed?
Diagnosis combines clinical assessment with laboratory testing of patient specimens. Testing may use blood or material from a swollen lymph node. When plague is strongly suspected, CDC advises collecting specimens if possible and starting antibiotics without waiting for final test results: CDC diagnosis and testing guidance.
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Yes. Plague can be treated with antibiotics, but prompt treatment is essential. CDC advises clinicians to begin appropriate therapy as soon as plague is suspected. U.S. clinical guidance lists gentamicin and fluoroquinolones as first-line options; treatment generally lasts 10–14 days, with the route and regimen selected by clinicians according to illness severity and patient factors. These are clinician-directed treatments, not medicines to obtain or take without medical supervision: CDC clinical care guidance.
Suspected plague calls for urgent professional care and notification of public health authorities. Do not try to diagnose or treat it yourself.
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What precautions apply to suspected pneumonic plague?
In healthcare settings, CDC emergency guidance calls for standard and respiratory droplet precautions for suspected or confirmed pneumonic plague patients during the first 48 hours of antimicrobial treatment and until the patient improves clinically or plague is ruled out: CDC guidance for healthcare professionals.
CDC’s 2021 review describes spread through large respiratory droplets and reports no evidence for airborne transmission. This does not mean every ordinary proximity is a meaningful exposure; the concern is infectious droplets during close contact with someone who has pneumonic plague: CDC Emerging Infectious Diseases review (2021).
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