Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1B93.Z

  • Yersin, 1894
  • Kitasato, 1894

Pestis, pestilentia, black death.

Notifiable infectious disease caused by the aerobic, gram-negative, "safety needle" bacterium.

  • Millions of plague deaths occurred in the Middle Ages
  • Endemically, it still occurs in Africa, Southeast Asia, India and on Indian reservations in the USA

  • Yersinia pestis is ingested by fleas as part of the sucking act and is ultimately transmitted to rodents and humans. The plague manifests itself cutaneously (bubonic plague)
  • in 90%
  • Pathogen: Yersinia pestis
  • Transmission: flea bites
  • Incubation period: 1-6 days

Bubonic plague (bubonic plague):

  • 90% of all plague cases
  • Reduced general condition, febrile temperatures, myalgias, arthralgias, tachycardia, delirium
  • Small papules or papulovesicles appear in the area of the portal of entry, which are usually overlooked
  • In the lymphatic drainage area, there is locoregional lymph node adenopathy
  • In bacteraemia, there is petechiae, ecchymosis, disseminated intravascular coagulopathy, sepsis and pulmonary involvement (black death)

Pneumonic plague: dyspnoea, haemoptysis, cyanosis

  • Anamnesis (travel anamnesis)
  • Clinical
  • Detection of pathogens: Bact. smear (sputum, bubones), blood culture
  • Serological antibody detection

  • Bubonic plague: untreated 50-90% lethality, treated 10-20%.
  • Pneumonic plague: untreated 100% lethality, treated 50%.

  1. Butler T. Plague and Other Yersinia Infections: Springer Science + Business Media; 1983.
  2. Butler T. Plague into the 21st Century. Clinical Infectious Diseases 2009;49:736-42.
  3. Cobbs CG , Chansolme DH. Plague. Dermatologic Clinics 2004;22:303-12.
  4. Kandi V. Human Nocardia Infections: A Review of Pulmonary Nocardiosis. Cureus 2015;7:e304.
  5. McCoy GW , Chapin CW. Further Observations on a Plague-Like Disease of Rodents with a Preliminary Note on the Causative Agent, Bacterium Tularense. Journal of Infectious Diseases 1912;10:61-72.
  6. Cavanaugh DC, Elisberg BL, Llewellyn CH, Marshall JD, Jr., Rust JH, Jr., Williams JE et al. Plague immunization. V. Indirect evidence for the efficacy of plague vaccine. J Infect Dis 1974;129:Suppl:S37-40.
  7. Welty TK, Grabman J, Kompare E, Wood G, Welty E, Van Duzen J et al. Nineteen cases of plague in Arizona. A spectrum including ecthyma gangrenosum due to plague and plague in pregnancy. West J Med 1985;142:641-6.
  8. Meyer KF. Modern therapy of plague. J Am Med Assoc 1950;144:982-5.
  9. Butler T, Bell WR, Nguyen Ngoc L, Nguyen Dinh T , Arnold K. Yersinia pestis infection in Vietnam. I. Clinical and hematologic aspects. J Infect Dis 1974;129:Suppl:S78-84.
  10. Butler T, Levin J, Linh NN, Chau DM, Adickman M , Arnold K. 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;133:493-9.
  11. Sexton, D. (2016). Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection). Retrieved 24 May 2016, from