Plague (Black Death)

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Steven Doerr, MD
    Steven Doerr, MD

    Steven Doerr, MD

    Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

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Is plague contagious? How is plague transmitted?

Bubonic and septicemic plague are only rarely spread from person to person; transmission occurs when fleas feed on infected rodents and then bite people. Transmission of pneumonic plague to another person typically requires direct and close (within 6 feet) contact with an infected person. Pneumonic plague is contagious because infected people can spread the bacteria via airborne droplets of respiratory secretions. This type of person-to-person spread of plague has not been reported in the U.S. since 1924, but it may still occur in some developing countries.

What is the contagious period for pneumonic plague?

Plague can be spread by the respiratory secretions of individuals with active infection of pneumonic plague. Though the exact contagious period is not definitively known, it is believed that patients in the early stage of pneumonic plague (the first 24 hours) pose little risk of transmitting the disease. However, patients in the final stages of pneumonic plague who are coughing up visible blood or pus pose a much higher risk of transmitting the disease.

How do physicians diagnose plague?

The diagnosis of plague depends upon identifying Yersinia pestis organisms in a sample of blood or tissue (such as an aspirate from an enlarged lymph node) from the infected patient. Diagnostic tests rely on culturing the organism, demonstrating the surface proteins of the bacteria, or identifying genetic material of the bacteria. Tests to identify the body's antibody response to the infection are also available.

What is the treatment for plague?

Antibiotics are effective in treating plague. Examples of antibiotics that can be used include ciprofloxacin (Cipro, Cipro XR, Proquin XR), streptomycin, gentamicin (Garamycin), and doxycycline (Vibramycin, Oracea, Adoxa, Atridox). People with plague are very ill and may require additional treatment, including oxygen, respiratory support, and medications to maintain adequate blood pressure. Patients with pneumonic plague must be isolated while in treatment to avoid spreading the infection.

What is the prognosis of plague?

Plague is a very serious illness that is often fatal. About 50% of people with bubonic plague die if their illness is not treated. Pneumonic plague is typically always fatal if untreated. With treatment, about half of people with pneumonic plague will survive. The earlier that antibiotic treatment is given, the better the chance for recovery.

Medically Reviewed by a Doctor on 10/8/2015
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