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Bubonic plague is one of three types of plague caused by bacterium Yersinia pestis.[1] One to seven days after exposure to the bacteria, flu-like symptoms develop.[1]Prevention is through public health measures such as not handling dead animals in areas where plague is common.[1]The plague was the cause of the Black Death that swept through Asia, Europe, and Africa in the fourteenth century and killed an estimated 50 million people.[1][2]

Signs and symptoms

The clinical presentation is consistent with fever, weakness, headaches, muscle pain; furthermore a infected person will develop a bubo, which is a inflamed swelling of lymph node.[3]


Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, Xenopsylla cheopis, the rat flea. In very rare circumstances, as in the septicemic plague, the disease can be transmitted by direct contact with infected tissue or exposure to the cough of another human.[4]


In its infection of the human body the Bubonic plague has many ways of circumventing the human immune system to then propagate within macrophages, afterwards, the infection causes a pro-inflammatory response.[4][5]


Laboratory testing is required in order to diagnose and confirm plague. Ideally, confirmation is through the identification of Y. pestis culture from a sample. Confirmation of infection can be done by examining serum taken during the early and late stages of infection.[6]


Several classes of antibiotics are effective in treating bubonic plague. These include aminoglycosides such as streptomycin and gentamicin, tetracyclines, and the fluoroquinolone ciprofloxacin. Mortality associated with treated cases of bubonic plague is about 1 to 15 percent, compared to a mortality of 40 to 60 percent in untreated cases.[7]


Plague cases were massively reduced during the second half of the twentieth century, but outbreaks still occurred, especially in developing countries. Between 1954 and 1997, human plague was reported in 38 countries, making the disease a re-emerging threat to human health.[8] Between 1987 and 2001, almost thirty seven thousand confirmed cases of plague with about three thousand deaths were reported to the World Health Organization.[9]

History 1

The first recorded epidemic affected the Sassanian Empire and their arch-rivals, the Eastern Roman Empire and was named the Plague of Justinian after emperor Justinian I, who was infected but survived through extensive treatment.[10][11]

History 2

In the Late Middle Ages Europe experienced the deadliest disease outbreak in history when the Black Death, the infamous pandemic of bubonic plague, hit in 1347, killing a third of the European population.[12]

History 3

The plague resurfaced for a third time in the mid-19th century, beginning in China and moving to India and Hong Kong, the bubonic plague killed several million victims.[13] Like the two previous outbreaks, this one also originated in Eastern Asia, most likely in Yunnan Province of China, where there are several natural plague foci.[14]


A theory that has been advanced is that the devastation in Florence caused by the Black Death, which hit Europe between 1348 and 1350, resulted in a shift in the world view of people in fourteenth century Italy. Italy was particularly badly hit by the plague, and it has been speculated that the resulting familiarity with death caused thinkers to dwell more on their lives on Earth, rather than on spirituality and the afterlife.[15] It has also been argued that the Black Death prompted a new wave of piety, manifested in the sponsorship of religious works of art.[16]


  1. 1.0 1.1 1.2 1.3 World Health Organization (November 2014). "Plague Fact sheet N°267". Archived from the original on 24 April 2015. Retrieved 10 May 2015.
  2. Haensch S, Bianucci R, Signoli M, Rajerison M, Schultz M, Kacki S, Vermunt M, Weston DA, Hurst D, Achtman M, Carniel E, Bramanti B (2010). "Distinct Clones of Yersinia pestis Caused the Black Death". PLOS Pathogens. 6 (#10): e1001134. doi:10.1371/journal.ppat.1001134. PMC 2951374. PMID 20949072.
  3. Sencen, Lisa. "Plague". NORD (National Organization for Rare Disorders). Retrieved 25 July 2022.
  4. 4.0 4.1 Dillard, Robert L.; Juergens, Andrew L. (2022). "Plague". StatPearls. StatPearls Publishing. Retrieved 26 July 2022.
  5. "Plague: Background, Pathophysiology, Epidemiology". emedicine (registration required). 16 October 2021. Retrieved 28 July 2022.
  6. "Diagnosis and treatment of plague | CDC". Centers for Disease Control and Prevention. 26 November 2019. Retrieved 28 July 2022.
  7. "Plague". Archived from the original on 5 March 2010. Retrieved 25 February 2010.
  8. Xu, Lei; Liu, Qiyong; Stige, Leif Chr.; Ben Ar, Tamara; Fang, Xiye; Chan, Kung-Sik; Wang, Shuchun; Stenseth, Nils Chr.; Zhang, Zhibin (2011). "Nonlinear effect of climate on plague during the third pandemic in China". Proceedings of the National Academy of Sciences. 108 (25): 10214–10219. Bibcode:2011PNAS..10810214X. doi:10.1073/pnas.1019486108. PMC 3121851. PMID 21646523.
  9. Shahraki, Abdolrazagh Hashemi; Carniel, Elizabeth; Mostafavi, Ehsan (2016). "Plague in Iran: its history and current status". Epidemiology and Health. 38: e2016033. doi:10.4178/epih.e2016033. PMC 5037359. PMID 27457063.
  10. Little, Lester K. (2007). "Life and Afterlife of the First Plague Pandemic." In: Little, Lester K. editor. (2007), Plague and the End of Antiquity: The Pandemic of 541–750. Cambridge University Press. (2007). ISBN 978-0-521-84639-4 pp. 8–15
  11. McCormick, Michael (2007). "Toward a Molecular History of the Justinian Pandemic." In: Little, Lester K. editor. (2007), Plague and the End of Antiquity: The Pandemic of 541–750. Cambridge University Press. (2007). ISBN 978-0-521-84639-4 pp. 290–312.
  12. Cohn, Samuel K.(2002). The Black Death: End of a Paradigm. American Historical Review, vol 107, 3, pg. 703–737
  13. "Pandemics That Changed History". HISTORY. Retrieved 2 August 2022.
  14. Nicholas Wade (31 October 2010). "Europe's Plagues Came From China, Study Finds". The New York Times. Archived from the original on 4 November 2010. Retrieved 2010-11-01.
  15. Barbara Tuchman (1978) A Distant Mirror, Knopf ISBN 0-394-40026-7.
  16. The End of Europe's Middle Ages: The Black Death Archived March 9, 2013, at the Wayback Machine University of Calgary website. (Retrieved April 5, 2007)