Usually through the bite of infected rodent fleas. Less common exposures include handling infected animal tissues (hunters, wildlife personnel), inhalation of infectious droplets from cats or dogs with plague, and rarely, contact with a pneumonic plague patient.
Endemic in rural areas in central and southern Africa, central Asia and the Indian subcontinent, the northeastern part of South America, and parts of the southwestern United States.
Incubation period is typically 1–6 days. Symptoms and signs of the 3 clinical presentations of plague illness are as follows:
Bubonic (most common)—rapid onset of fever; painful, swollen, and tender lymph nodes, usually inguinal, axillary, or cervical
Septicemic—fever, prostration, hemorrhagic or thrombotic phenomena, progressing to acral gangrene
Y. pestis can be isolated from bubo aspirates, blood cultures, or sputum culture if pneumonic. Diagnosis can be confirmed in public health laboratories by culture or serologic tests for the Y. pestis F1 antigen.
Parenteral antibiotic therapy with streptomycin is the recommended first-line therapy; alternatively, gentamicin or, where treatment is limited to oral therapy, doxycycline can be used.
Reduce contact with fleas and potentially infected rodents and other wildlife.