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What To Know About Pneumonic Plague

Pneumonic plague occurs when plague bacteria enter the lungs. It is the only form of plague that can spread between people. Symptoms may include headache, fever, and rapidly developing pneumonia.

Plague can affect humans and other mammals. The bacteria that causes plague, Yersinia pestis, typically transmits through flea bites but can also spread by other means.

The disease requires prompt treatment with antibiotics. Pneumonic plague is the most severe form of the condition and can be fatal without treatment.

This article explores pneumonic plague in more detail, including its causes, symptoms, and diagnosis. The article also discusses how doctors treat pneumonic plague and how people can help prevent its transmission.

Yersinia pestis is the bacteria that causes plague. There are three main forms of the disease:

Plague affects nonhuman animals across all continents, except Oceania, according to the World Health Organization (WHO). It rarely affects humans but is more likely to occur in rural areas in the western United States and certain regions of Asia and Africa.

Yersinia pestis can transmit to humans through:

  • Fleabites: The bacteria most commonly transmits through bites from fleas. Plague outbreaks typically affect rodents. If a rodent dies from the disease, fleas that were feeding on them start to feed on other animals, such as dogs and cats. These animals may then carry bacteria-containing fleas into closer proximity to people.
  • Contact with bacteria-containing body fluids or tissues: The bacteria may spread to a person if they handle the tissue or body fluids of an animal with the disease. For example, if a hunter skins an animal without using gloves or following other proper precautions, they may contract Yersinia pestis. People most commonly develop bubonic or septicemic plague from this type of exposure.
  • Bacteria-containing droplets: If humans and other mammals have pneumonic plague, they may cough bacteria-containing droplets into the air. These droplets can cause pneumonic plague if a person or nonhuman mammal inhales them, typically following direct or close contact with a person or nonhuman animal with the disease. This is the only way that plague can spread between people.
  • Pneumonic plague can also develop when Yersinia pestis spreads to the lungs of someone with untreated bubonic or septicemic plague.

    According to the WHO, symptoms of pneumonic plague may include:

    These symptoms may come on suddenly.

    Additionally, pneumonic plague may cause rapidly developing pneumonia with:

    If someone develops pneumonic plague after the bacteria has spread to the lungs due to untreated bubonic or septicemic plague, they may experience other symptoms, such as swollen lymph nodes.

    People need to seek immediate medical attention if they are experiencing the above symptoms. Without treatment, plague can lead to potentially life threatening complications.

    A doctor may begin the diagnostic process by looking for physical signs of plague, such as fleabites or swollen lymph nodes.

    However, there may not be any obvious signs of pneumonic plague.

    Therefore, healthcare professionals may take blood, pus, or sputum samples to test in a laboratory following evaluation of a person's symptoms, according to the WHO.

    Doctors may begin treatment for plague before confirming the final test results to help prevent complications.

    Healthcare professionals treat pneumonic plague with antibiotics.

    The earlier a person receives treatment, the better their outlook. According to the WHO, pneumonic plague can be fatal within 18 to 24 hours of symptom onset without treatment.

    Doctors may also need to treat complications of plague.

    Additionally, they may evaluate people who have been in close contact with someone with pneumonic plague. In some cases, they may put them under observation and prescribe preventive antibiotics.

    Individuals who live in areas where plague outbreaks are more likely to occur can take the following steps to help prevent Yersinia pestis infection:

  • Rodent proof the home and yard: People need to store pet and wild animal food in well-sealed containers. A person also needs to remove potential rodent habitats surrounding their home, such as rock piles or cluttered firewood.
  • Take hygiene precautions: A person needs to avoid contact with dead animals and contact their local health department to learn about disposing of them safely. People need to wear gloves if they are handling animals that may have contracted plague.
  • Use insect repellent: Individuals need to apply insect repellent during activities, such as hiking, camping, or working outdoors, in case of exposure to fleas. They can apply products containing permethrin to clothes and DEET to the skin.
  • Use flea control products on pets: Animals that roam freely may acquire fleas. People can help prevent fleas by applying flea control products to their pets. They also need to take their pet to a veterinarian if it contracts fleas or becomes sick.
  • Keep pets off beds: A person needs to prevent pets that roam freely from sleeping on their bed.
  • The WHO does not recommend vaccination for plague, except for certain high risk groups of people. This typically includes laboratory staff, who often receive exposure to samples that may contain Yersinia pestis, as well as other healthcare workers.

    A 2022 review suggested that while pneumonic plague outbreaks are relatively rare at present, the following factors could contribute to the risk of future outbreaks:

  • Antibiotic resistance: Similar to other types of bacteria, Yersinia pestis can develop resistance to certain antibiotics. Previous research has documented some antibiotic-resistant strains of Yersinia pestis.
  • Climate change: Changes in environmental factors, such as temperature and humidity, can affect how quickly and far infectious diseases spread. This may mean outbreaks are more likely in certain areas.
  • Bioweaponry: Some studies suggest that plague is a potential candidate as a future bioweapon. People have used bacteria-containing fleas and dead bodies as bioweapons during wars in the past.
  • People can help combat antibiotic resistance by taking antibiotics only when necessary and exactly as their doctor has instructed.

    Many factors contributing to climate change require systemic change. However, a person can also make lifestyle changes, such as following a sustainable diet, to help reduce their effect on the environment.

    Pneumonic plague is a form of plague that results from a Yersinia pestis infection.

    It may occur following contact with bacteria-containing droplets from a person or another mammal with pneumonic plague. Alternatively, it may develop when Yersinia pestis reaches the lungs due to untreated bubonic or septicemic plague.

    Symptoms of pneumonic plague may include fever, headache, and rapidly developing pneumonia. Treatment always involves antibiotics.

    People living in certain areas can take steps to prevent the spread of plague, such as rodent-proofing their homes, using insect repellents, and preventing free-roaming pets from sleeping in their beds.

    If a person experiences symptoms that may indicate pneumonic plague, they need to seek immediate medical attention. Prompt treatment is essential to prevent potentially life threatening complications.


    Scientists Say They've Found The Earliest Case Of The Plague Yet

    The skull of a hunter-gatherer who lived in Europe over 5,000 years ago contains the oldest known traces of the bacteria responsible for causing the plague, according to a new study. The discovery is likely to yield some important clues as to the origins and evolution of this long-time germ foe, which has been responsible for some of the worst epidemics in human history.

    Plague is caused by Yersinia pestis bacteria and is usually spread through contact with animals or from bites of fleas they carry; in this form, it's known as bubonic plague. It also can become a very serious respiratory disease spread between people, known as pneumonic plague. The third, very rare, and often fatal form is called septicemic plague and happens when the bacteria reach the bloodstream.

    "The most important finding of our research is that we can date the split from Y. Pestis to its closest relative... Earlier than previously thought" 

    Though now largely contained through better sanitation and the availability of antibiotics, in the middle ages, plague would regularly sweep through Europe, Asia, and Africa, leaving behind devastation in its wake. The Black Death in the mid-14th century is thought to be one of the most lethal pandemics ever, killing around a third of Europe's entire population and at least 50 million people worldwide.

    Just like every other living thing, the germs that cause human diseases evolve over time. Scientists have been deeply interested in unraveling when Y. Pestis first encountered humanity and how it eventually changed into something capable of causing the Black Death. But the international team of researchers behind this new research say they weren't even intending to find ancient plague where they did.

    According to their study, published Tuesday in Cell Reports, they were simply looking for any DNA traces left behind in the skull remains of a young man buried approximately 5,000 to 5,300 years ago near the River Salaca in Latvia, close to a shell midden site called Rinnukalns (shell middens are places where early humans left behind trash and evidence of their domestic life, particularly mollusk shells and animal bones). Luckily, this analysis included screening for potential pathogens, and that's when they found bits of DNA coding for proteins known to be specific to Y. Pestis. From these bits, they then reconstructed the genome of this strain, dubbed RV 2039 (the same designation given to the man) and compared what they found to other ancient strains that have been reconstructed.

    The researchers say RV 2039 precedes any of these other samples of Y. Pestis and may represent the beginnings of its evolution as a distinct species, albeit a lineage that went extinct. If their findings are valid, it could also change certain assumptions about how these bacteria existed back then.

    "The most important finding of our research is that we can date the split from Y. Pestis to its closest relative Y. Pseudotuberculosis, a relatively harmless soil bacterium, to about 7300 years before today. This is earlier than previously thought, and the strain we found emerges shortly after this split." lead author Ben Krause-Kyora, a molecular biologist and professor of ancient DNA analysis at the Christian-Albrecht University of Kiel in Germany, told Gizmodo in an email.

    Furthermore, Krause-Kyora and his team say there's evidence that this version of plague was tamer than the version behind the Black Death.

    For one, like other ancient plague strains, these bacteria lack the adaptations that allowed them to spread from fleas, which is thought to have kickstarted their evolution into a more virulent disease. Because the DNA seems to have been recovered from the man's bloodstream, though, it's possible that he might have died from a deadly form of plague. But the sheer amount of plague DNA found suggests that the infection could have been tolerated without causing death, the researchers say, citing research showing that mice with high loads of modern plague bacteria tend to experience less disease.

    In any case, the discovery of the man carefully buried alongside others with no plague suggests that, whatever he had, it wasn't considered highly contagious by the human populations of that time. And combined with evidence from other ancient plague cases, the authors argue that this version may have not been capable of causing large epidemics as its descendents eventually would. If true, that would put a serious dent in a recent theory that the early emergence of pneumonic plague caused a widespread pandemic around then, fueled by trade routes between Neolithic settlements.

    "The presence of the early strains over 2000 years ago and their spread across Eurasia without any signs of epidemics suggests that the early forms caused isolated outbreaks that ended in a dead-end," Krause-Kyora said. "This picture would fit well with a zoonosis where animals infect humans directly, e.G. Through a bite."

    It's likely that this debate about ancient plague won't be settled by a single study. But its findings are incredible for another reason, the researchers say.

    The burial site and skull were actually first discovered in the late 19th century by the amateur archaeologist Carl Georg Count Sievers. Sievers and his mentor, the German doctor Rudolf Virchow, argued that the site had to be prehistoric, but their theory was roundly criticized by others of the time. Eventually, the man's skull seemingly vanished after World War II but was rediscovered in the collections of Virchow's work maintained by the Berlin Society for Anthropology, Ethnology, and Prehistory in 2011; subsequent carbon dating then confirmed its old age, vindicating Sievers and Virchow.

    "Virchow was in no position to diagnose plague with the Rinnukalns cranium. However, thanks to Virchow's progressive scientific approach, the remains excavated by Sievers were stored in his collection, where they survived the vicissitudes of time unscathed, so that a later diagnosis was still possible, even after 145 years," the authors wrote.

    As for their own work, they plan to keep looking further for ancient germs.

    "Our team is working on a larger project in which we are trying to screen a large number of prehistoric individuals for pathogen exposure. So we hope to come across the plague or other pathogens in the future," Krause-Kyora said. "We have also started to investigate rodents as natural hosts for the plague."

    This article has been updated with comments from study author Ben Krause-Kyora

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    Plague Is Rare But Still Exists. Here Are A Few Things To Know About The Illness

    Officials in central Oregon this week reported a case of bubonic plague in a resident who likely got the disease from a sick pet cat.

    The infected resident, the cat, and the resident's close contacts have all been provided medication, public health officials say, and people in the community are not believed to be at risk.

    Plague isn't common, but it also isn't unheard of in the western United States, where a handful of cases occur every year. It's different from Alaskapox, a rare, recently discovered disease that killed a man in Fairbanks, Alaska, last month.

    Here are a few things to know about what the plague is, who is at risk and how a disease that was once a harbinger of death became a treatable illness.

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  • What is plague?

    Plague is an infectious disease that can affect mammals. It's caused by the bacterium Yersinia pestis, which is carried by rodents and fleas. Sunlight and drying can kill plague bacteria on surfaces, according to the U.S. Centers for Disease Control and Prevention. Humans and pets suspected to be sick with plague are typically treated with antibiotics, and sometimes with other medical measures.

    Plague symptoms can manifest in a few ways. Bubonic plague — the kind contracted by the Oregon resident — happens when the plague bacteria gets into the lymph nodes. It can cause fever, headache, weakness and painful, swollen lymph nodes. It usually happens from the bite of an infected flea, according to the CDC.

    Septicemic plague symptoms happen if the bacteria gets into the bloodstream. It can occur initially or after bubonic plague goes untreated. This form of plague causes the same fever, chills and weakness, as well as abdominal pain, shock and sometimes other symptoms like bleeding into the skin and blackened fingers, toes or the nose. The CDC says this form comes from flea bites or from handling an infected animal.

    Pneumonic plague is the most serious form of the disease, and it occurs when the bacteria gets into the lungs. Pneumonic plague adds rapidly developing pneumonia to the list of plague symptoms. It is the only form of plague that can be spread from person to person by inhaling infectious droplets.

    All forms of plague are treatable with common antibiotics, and people who seek treatment early have a better chance of a full recovery, according to the CDC.

    Am I at risk of plague?

    In the U.S., an average of 7 cases of human plague is reported each year, according to the CDC, and about 80% of them are the bubonic form of the disease. Most of those cases were in the rural western and southwestern U.S.

    A welder in central Oregon contracted it in 2012 when he pulled a rodent out of his choking cat's mouth in 2012 — he survived but lost his fingertips and toes to the disease. A Colorado teen contracted a fatal case while hunting in 2015, and Colorado officials confirmed at least two cases last year — one of them fatal.

    Worldwide, most human cases of plague in recent decades have occurred in people living in rural towns and villages in Africa, particularly in Madagascar and Congo, according to the Cleveland Clinic.

    People can reduce the risk of plague by keeping their homes and outdoor living areas less inviting for rodents by clearing brush and junk piles and keeping pet food inaccessible. Ground squirrels, chipmunks and wood rats can carry plague as well as other rodents, and so people with bird and squirrel feeders may want to consider the risks if they live in areas with a plague outbreak.

    The CDC says repellent with DEET can also help protect people from rodent fleas when camping or working outdoors.

    Flea control products can help keep fleas from infecting household pets. If a pet gets sick, they should be taken to a vet as soon as possible, according to the CDC.

    Isn't plague from the Middle Ages?

    The Black Death in the 14th century was perhaps the most infamous plague epidemic, killing up to half of the population as it spread through Europe, the Middle East and northern Africa. It began devastating communities in the Middle East and Europe between 1347 and 1351, and significant outbreaks continued for roughly the next 400 years.

    An earlier major plague pandemic, dubbed the Justinian plague, started in Rome around 541 and continued to erupt for the next couple hundred years.

    The third major plague pandemic started in the Yunnan region of China in the mid-1800s and spread along trade routes, arriving in Hong Kong and Bombay about 40 years later. It eventually reached every continent except Antarctica, according to the Cleveland Clinic, and is estimated to have killed roughly 12 million people in China and India alone.

    In the late 1800s, an effective treatment with an antiserum was developed. That treatment was later replaced by even more effective antibiotics a few decades later.

    Though plague remains a serious illness, antibiotic and supportive therapy is effective for even the most dangerous pneumonic form when patients are treated in time, according to the World Health Organization.

    Top 10 states with the healthiest seniors Top 10 states with the healthiest seniors

    The health of a community can have a large impact on the local economy. It can influence the demand – or lack thereof – for specific goods, services, and infrastructure. In the case of seniors, health may be an indicator of longevity and overall well-being, dictating how insurance products and retirement planning should be laid out.

    With this in mind, SmartAsset ranked all states (except for Florida, for which data was not available) on health metrics across the population aged 65 and older, including obesity, smoking, arthritis, mental distress, disability status and more, to find where seniors are healthiest.

    Key findings
  • New Hampshire seniors are healthiest. Just over 83% of people aged 65 and older in New Hampshire claim their health to be "good" or "excellent." The state ranks in the top 10 for every attribute of senior health, from obesity to smoking to mental health.
  • Hawaiian seniors have the lowest rates of obesity. Hawaii ranked second overall for healthy seniors, thanks in part to only 16.6% of seniors qualifying as obese. Colorado, which ranked eighth overall, has the second-lowest rate of obesity at 23.0%.
  • Colorado seniors have a relatively high rate of cognitive decline. Colorado generally ranks among the top 10 for most attributes across senior health, but second-to-last when it comes to experiencing cognitive decline (15.6%, compared to 16.2% in Tennessee). On the other hand, Colorado has the lowest disability rate for seniors (21.5%), as well as the highest rate of seniors participating in physical activity in their leisure time (78.5%). 
  • Seniors are least healthy in these southern states. Louisiana ranked last for senior health, with Kentucky, West Virginia and Tennessee following closely. In particular, West Virginia seniors ranked worst for both obesity (36%) and number of days spent with mental distress (12.6 days), while Tennessee has the most senior smokers (15%) and those experiencing cognitive decline (16.2%).
  • Utah has the lowest rate of senior smokers. Only 4% of the population aged 65 and older partakes in smoking. Illinois (6.2%) and Connecticut (6.7%) also had relatively few smokers in this age bracket.
  • Monkey Business Images // Shutterstock Top 10 states with the healthiest seniors
  • New HampshireIn New Hampshire, 83.5% of seniors reported their health as good to excellent. The obesity rate stood at 26.2%, while 7.4% are current smokers. Among seniors, 18.9% had arthritis, 7.1% experienced frequent mental distress and 8.9% noted cognitive decline. Disabilities were reported by 36.4%, and 26.9% lacked leisure-time physical activity.
  • HawaiiHawaiian seniors rated their health positively at 81.4%, with the obesity rate being relatively low at 16.6%. Smoking was reported by 7%, while 18.7% had arthritis. Mental distress affected 7.1%, and 12.2% experienced memory loss. 37.9% had disabilities, and 25.4% did not participate in leisure-time physical activity.
  • Vermont83.1% of Vermont's senior population self-rated their health as good to excellent. Obesity affected 26.9%, with 9.1% being smokers. Arthritis prevalence was in 17.8% of seniors, and 7.3% suffered from mental distress. Cognitive decline was noted by 8.7%, disability by 37.7% and 24.9% did not engage in leisure-time physical activity.
  • WashingtonIn Washington, 81% of seniors reported good to excellent health, while 27% are considered obese and 7.7% are smokers. Arthritis was noted for 17.1% of seniors, and 8.3% experienced mental distress. There were 9.4% with cognitive decline, 36.9% with disabilities and 22.3% abstained from physical activity during leisure time.
  • WisconsinWisconsin's older adults had an 82.2% good to excellent health rate, but obesity was higher at 32.4%. Smoking was at 7.6%, arthritis at 18.6% and mental distress at 6%. Cognitive decline was reported by 11.1%, disabilities by 35.3%, and lack of physical activity by 26.6%.
  • ConnecticutConnecticut's seniors ranked their health as good to excellent 81.5% of the time. The state had a 27% obesity rate and 6.7% smoking rate for seniors. Arthritis was reported by 22.8%, mental distress by 7.3% and cognitive decline by 8.4%. Disabilities were noted by 38.7%, and 29.2% did not engage in leisure-time physical activity.
  • MinnesotaIn Minnesota, 82.1% of seniors felt they had good to excellent health, despite a 30.7% obesity rate. Current smoking was at 8.5%, arthritis at 17.5%, and mental distress at 5.9%. Cognitive decline was observed by 11.1%, disabilities by 39.5% and 27.6% did not engage in physical activity.
  • ColoradoColorado's elderly reported an 82.4% rate of good to excellent health and a lower obesity rate of 23%. Smokers comprised 8.6%, and 20.4% of seniors reported arthritis. Mental distress was at 7.2%, and 15.6% experienced cognitive decline. Disabilities were at 35.1%, with 21.5% avoiding physical activity.
  • MassachusettsMassachusetts seniors rated their health as good to excellent 79.8% of the time, the lowest among the top 10, with a 26.1% obesity rate. Smoking was at 7.6%, arthritis at 21.4%, and mental distress at 7.9%. Cognitive decline was reported by 8.8%, disabilities by 39.7%, and 27.6% did not engage in leisure-time physical activity.
  • OregonOregon's senior health rating was at 81.2%, with an obesity rate of 25.2%. Smokers accounted for 8.4%, arthritis for 17.8%, and mental distress for 7.6%. Notably, 12.5% reported cognitive decline, 42.1% had disabilities and 22.2% did not participate in physical activities.
  • Data and methodology

    U.S. States were ranked according to eight health variables for people aged 65 and older. These included:

  • Overall self-rated health as good to excellent 
  • Obesity
  • Current smoking
  • Arthritis
  • Frequent mental distress
  • Functional difficulties associated with subjective cognitive decline or memory loss
  • Disability status, including sensory or mobility limitations
  • Leisure-time activity in the last 12 months, and lack thereof
  • Data comes from the Centers for Disease Control and Prevention and reflects the most recent available data (2021). 

    Limitations: Florida was excluded from this study due to a lack of available data. Self-reported data may be prone to biases across individuals.

    This story was produced by SmartAsset and reviewed and distributed by Stacker Media.

     

    SmartAsset

    Copyright 2024 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

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