Pneumonic Plague

When you think of the plague, the image of the Middle Ages often comes to mind. However, there are still minor outbreaks of the disease. Pneumonic plague is the second form of plague next to bubonic plague. While many years ago around 20 million people fell victim to the plague, today it is around 1000 to 2000 per year.

Pneumonic Plague

What is pneumonic plague?

According to Electronicsencyclopedia, the plague is a bacterial disease. This can be very different. In the case of pneumonic plague, on the other hand, the course is almost always acute. If left untreated, those affected have no chance of survival. There are different forms of plague, all of which are transmitted by the same pathogen. The plague is also known as the Black Death, a reference to earlier epidemics.

Actually, the plague is a disease of rodents. However, humans can become infected either directly through contact with infected animals or through human-to-human exchanges. Of the different forms of plague, pneumonic plague is the least common, but no less devastating.

The pathogen is transmitted by droplet infection and thus comes into direct contact with the lungs. The immune system reacts too late and various symptoms such as bloody sputum occur. If left untreated, pneumonic plague is fatal for many of those affected. If the patient is already suffering from another form of plague, the pathogen can enter the lungs via the blood and trigger secondary pneumonic plague.


Pneumonic plague is caused by the bacterium Y. pestis. This has been known for 1000 years. Especially in earlier times, the plague cost many people their lives. The main reason was a lack of knowledge about adequate protection and treatment. Research has now shown that the bacterium is mainly found in rodents and is transmitted to humans by fleas.

Risk factors include rats or poor hygiene standards in the home. In addition, infection via humans is also possible. Accordingly, caring for a sick person also poses a risk. In western latitudes, pneumonic plague already seems to have disappeared. However, outbreaks still occur.

These are usually regionally limited and can be localized, for example, in Madagascar, Congo, China, India, Peru and the south-west of the USA. In Germany, on the other hand, no case of illness has been reported for decades.

Symptoms, Ailments & Signs

In pneumonic plague, the bacterium has entered the lungs. The first symptoms are usually noticeable after a few hours. First there is fever and general weakness. Serious symptoms such as abdominal pain and bloody sputum can appear as early as the second day.

The heart rate increases and many of those affected suffer from shortness of breath. Due to the strong urge to cough, vomiting is also possible. Patients complain of chills, headaches, blue lips and fatigue. Coughing up the phlegm is very painful. Pulmonary edema can develop as the disease progresses.

Overall, circulatory failure cannot be ruled out. The pathogen can be detected in both sputum and saliva. This means that people suffering from pneumonic plague pose a serious risk of infection for healthy people. The bacterium can be transmitted, for example, via a droplet infection that is triggered by a sneeze.

Diagnosis & disease progression

The symptoms are not always immediately assigned to pneumonic plague. Instead, the disease can be misdiagnosed as pneumonia, for example. Proof of the bacterium is necessary for clear verification. For this purpose, samples of the mucus or blood are taken and examined accordingly in the laboratory.

If pneumonic plague is not recognized and treated early, the probability of death is very high. About 95 percent of those affected do not survive the disease in this case. Appropriate treatment reduces the risk to 15 percent.


Pneumonic plague is a very serious disease that can usually lead to death if left untreated. Although it doesn’t happen very often, it definitely needs to be checked out and treated by a doctor. Those affected primarily suffer from fever and abdominal pain. The patient becomes generally weak and those affected suffer from exhaustion.

Shortness of breath also continues to occur, resulting in an undersupply of oxygen to the body. Those affected suffer from headaches and blue-stained lips. Loss of consciousness can also occur. If the pneumonic plague is not treated, circulatory failure can also occur and lead to the death of the affected person.

However, complications usually only occur if the disease is left untreated or misdiagnosed as pneumonia. Pneumonic plague is also highly contagious, so those affected must avoid contact with other people. The treatment of pneumonic plague can be carried out with the help of antibiotics and usually leads to a positive course of the disease. Complications usually do not arise. With successful and, above all, early treatment, the life expectancy of the person affected is not reduced or restricted.

When should you go to the doctor?

If symptoms such as shortness of breath or coughing suddenly become noticeable, a doctor must be consulted. Pneumonic plague may be the cause, which needs to be investigated and treated if necessary. If there are external signs such as the characteristic blue discoloration of the lips, an immediate doctor’s visit is necessary. Medical advice is required at the latest when cardiovascular problems, headaches or fatigue occur. Other warning signs to look for include bloody sputum, severe pain, and a throbbing sensation in the lungs.

Pneumonic plague progresses very quickly and leads to serious complications such as blood poisoning and organ failure. Rapid clarification is therefore essential, especially if there is a concrete suspicion. A doctor must be consulted if the symptoms mentioned occur in connection with a flea or rat bite or a trip to Asian countries. People who suffer from bubonic plague or have someone nearby who has the disease are also at risk and should seek medical advice quickly. Pneumonic plague must be treated by a general practitioner or a pulmonary specialist.

Treatment & Therapy

Once the pathogen has been identified, the patient is isolated to protect healthy individuals from contagion. The room may only be entered on the basis of specific security regulations. Unnecessary contact is not allowed. Antibiotics are used to treat pneumonic plague. For this purpose, for example, agents such as streptomycin, gentamycin and tetracyclines such as doxycycline or chloramphenicol are used.

In order to avoid complications that negatively affect the course of the disease, treatment must begin as early as possible. A quick diagnosis can save the patient’s life. During the last outbreak of plague in Madagascar, experts were able to determine that the pathogen responsible no longer reacted to the antibiotics used. The bacterium has thus become resistant.

It may therefore be necessary to use another antibiotic preparation. Even after the start of therapy, patients remain contagious. People suffering from pneumonic plague will continue to be isolated for at least four days after they first take the antibiotic. Only then is it possible to lift the quarantine. After surviving an infection, those affected have a certain immunity. Re-infection is still possible.

Outlook & Forecast

The prognosis of pneumonic plague has improved significantly compared to the last millennium. If left untreated, it still inevitably leads to the premature death of the patient. In an advanced stage of the disease, there is also little chance of recovery. Pathogens spread too quickly within a short period of time and lead to the failure of the human organism to function properly. On the other hand, a good prognosis is given to people who have a healthy and stable immune system, who have no other previous illnesses and who consult a doctor in the early stages of pneumonic plague.

The highly contagious disease is immediately treated with medication. In addition, it is necessary to isolate the patient so that no other people can be infected by the pathogens. The progression of the disease is characterized by a rapid increase in symptoms and a rapid spread of physical irregularities. Within a few hours, the intensity of the physical impairments increases. In order for there to be a chance of survival, the person concerned must be monitored and cared for immediately in intensive care. Otherwise there is little prospect of an improvement in the situation.

If complications or intolerance to the administered medication occur, the chances of recovery deteriorate further. Although there are various alternative medications available thanks to medical advances, speedy action is imperative for recovery.


Pneumonic plague is preventable to a limited extent. Specific safety measures apply, especially in regions where the pathogen occurs. Travelers are best advised to avoid contact with rodents altogether. Care should be taken, especially with sick and dead animals. Bug sprays that contain DEET prevent fleas from infecting humans.

All pets should not be forgotten: they should be regularly freed from fleas. In addition, unnecessary contact with sick people should be avoided. The same goes for clothing that has been around victims and rodents.


Because pneumonic plague is a very serious disease, follow-up care focuses primarily on maintaining the quality of life of those affected at an appropriate level. Pneumonic plague is rare but can be completely cured, so it’s important to take follow-up care seriously. Those affected should take it easy and only carefully return to their usual rhythm.

Once the acute phase is over, those affected are dependent on help to cope with everyday life despite persistent exhaustion and general weakness. Since pneumonic plague is highly contagious, those affected must avoid contact with the outside world and family members. This significantly reduces the quality of life. Antibiotics are usually prescribed for treatment. Normally, the disease can be successfully cured with it. There are no complications. Prompt treatment does not shorten the life expectancy of those affected.

You can do that yourself

Pneumonic plague is an extremely rare, but very dangerous and, above all, highly contagious infectious disease in western countries. Pneumonic plague must be treated by a doctor as soon as possible, otherwise the risk of morbidity is over 90 percent. Self-help measures are only indicated insofar as the patient can help ensure that the disease is correctly diagnosed and the risk to third parties is kept as low as possible.

In the early stages, pneumonic plague resembles pneumonia and, due to its rare occurrence, is very often misdiagnosed, which can be life-threatening for the patient. Anyone who has traveled to a risk area shortly before the outbreak of the disease and shows symptoms typical of pneumonic plague must explicitly inform their doctor of this circumstance. The risk areas mainly include developing and emerging countries such as the Republic of Congo, Madagascar, the Chinese hinterland, parts of India and Peru. Occasionally, however, pneumonic plague is also observed in the south-western states of America.

Since the disease can be transmitted by droplets and the pathogen is extremely aggressive, the patient must be isolated immediately. For these reasons, care at home should be avoided. All medical quarantine regulations must be strictly observed. This also applies when children are involved. Parents are doing their offspring a disservice if they endanger themselves or even infect other family members out of excessive care.