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Record updated Sources on file 27 262 views

Pneumonic Plague Symptoms

Not medical advice. This page reports what WHO, CDC, ECDC, PHAC and the peer-reviewed literature state. It does not diagnose or treat anybody.

The three forms of plague, what each one does to a patient, and how fast.

Updated · 11 sources, 3 with a DOI

The three forms at a glance

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The three forms at a glanceBubonicTransmission routeBite of an infected rodent flea, or handling aninfected animalWorld Health Organization: Plague (fact sheet)[3]Centers for Disease Control and Prevention: About Plague[5]Incubation2 to 8 daysCenters for Disease Control and Prevention: Signs and Symptoms of Plague[1]Hallmark signSwollen, painful lymph node, the buboWorld Health Organization: Plague (fact sheet)[3]Centers for Disease Control and Prevention: Signs and Symptoms of Plague[1]Fatality untreated30 to 60%World Health Organization: Plague (fact sheet)[3]SepticaemicTransmission routePrimary, or a complication of untreated bubonic plagueEuropean Centre for Disease Prevention and Control: Facts about plague[2]Incubation2 to 6 daysEuropean Centre for Disease Prevention and Control: Facts about plague[2]Hallmark signBleeding into the skin, tissue death in the extremitiesCenters for Disease Control and Prevention: Signs and Symptoms of Plague[1]World Health Organization: Plague (questions and answers)[6]Fatality untreatedAlmost always fatalEuropean Centre for Disease Prevention and Control: Facts about plague[2]PneumonicThe only form that spreads person to personWorld Health Organization: Plague (questions and answers)[6]Transmission routeInhaling respiratory droplets from a person or animalwith pneumonic plagueEuropean Centre for Disease Prevention and Control: Facts about plague[2]World Health Organization: Plague (questions and answers)[6]Incubation1 to 3 daysEuropean Centre for Disease Prevention and Control: Facts about plague[2]Public Health Agency of Canada: Pathogen Safety Data Sheet: Yersinia pestis[7]Hallmark signRapid pneumonia with bloody or watery sputumEuropean Centre for Disease Prevention and Control: Facts about plague[2]World Health Organization: Plague (questions and answers)[6]Fatality untreated98%Salam AP, Rojek AM, Cai E, Raberahona M, Horby P: Deaths Associated with Pneumonic Plague, 1946-2017[4]The three forms at a glanceBubonicSepticaemicPneumonicThe only form that spreadsperson to personWorld Health Organization: Plague (questions and answers)[6]TransmissionrouteBite of an infected rodentflea, or handling aninfected animalWorld Health Organization: Plague (fact sheet)[3]Centers for Disease Control and Prevention: About Plague[5]Primary, or a complicationof untreated bubonicplagueEuropean Centre for Disease Prevention and Control: Facts about plague[2]Inhaling respiratorydroplets from a person oranimal with pneumonicplagueEuropean Centre for Disease Prevention and Control: Facts about plague[2]World Health Organization: Plague (questions and answers)[6]Incubation2 to 8 daysCenters for Disease Control and Prevention: Signs and Symptoms of Plague[1]2 to 6 daysEuropean Centre for Disease Prevention and Control: Facts about plague[2]1 to 3 daysEuropean Centre for Disease Prevention and Control: Facts about plague[2]Public Health Agency of Canada: Pathogen Safety Data Sheet: Yersinia pestis[7]HallmarksignSwollen, painful lymphnode, the buboWorld Health Organization: Plague (fact sheet)[3]Centers for Disease Control and Prevention: Signs and Symptoms of Plague[1]Bleeding into the skin,tissue death in theextremitiesCenters for Disease Control and Prevention: Signs and Symptoms of Plague[1]World Health Organization: Plague (questions and answers)[6]Rapid pneumonia withbloody or watery sputumEuropean Centre for Disease Prevention and Control: Facts about plague[2]World Health Organization: Plague (questions and answers)[6]Fatalityuntreated30 to 60%World Health Organization: Plague (fact sheet)[3]Almost always fatalEuropean Centre for Disease Prevention and Control: Facts about plague[2]98%Salam AP, Rojek AM, Cai E, Raberahona M, Horby P: Deaths Associated with Pneumonic Plague, 1946-2017[4]

One of the three spreads between people. That one is pneumonic.

  • Official incubation ranges for bubonic plague differ. CDC gives 2 to 8 days, PHAC gives 2 to 10, ECDC gives 2 to 6. CDC's range is the one shown.172
  • WHO gives 30 to 60% untreated for bubonic plague and ECDC gives 40 to 70%. WHO's figure is the one shown.32
  • Bubo size and shape did not correlate with how ill the patient was, so a larger bubo is not a sicker patient.8
  • The 98% untreated pneumonic figure is a pooled rate, 95% confidence interval 73 to 100%. WHO states untreated pneumonic plague is always fatal.43

Pneumonic plague, hour 0 to day 4

3219410
Pneumonic plague, hour 0 to day 41Hour 0Exposure. Inhaling respiratory droplets from aperson or animal with pneumonic plague. WHO adviseskeeping more than 2 metres from a coughing person.World Health Organization: Plague (questions and answers)[6]European Centre for Disease Prevention and Control: Facts about plague[2]2Hour 24Symptoms can already start. Incubation can be asshort as 24 hours.World Health Organization: Plague (fact sheet)[3]3Day 1 to 3The full incubation range for the pneumonic form. Apatient can still be symptom free.European Centre for Disease Prevention and Control: Facts about plague[2]Public Health Agency of Canada: Pathogen Safety Data Sheet: Yersinia pestis[7]4OnsetFever, headache, weakness, then a rapidly developingpneumonia.Centers for Disease Control and Prevention: Signs and Symptoms of Plague[1]5Within hoursChest pain, cough, difficulty breathing, bloody orwatery sputum.European Centre for Disease Prevention and Control: Facts about plague[2]World Health Organization: Plague (questions and answers)[6]6Within 24 h of onsetThe treatment window. Antimicrobials should be giveninside it, and recovery rates are high when theyare.Centers for Disease Control and Prevention: Guidance for Responding to a Plague Bioterrorism Event[9]World Health Organization: Plague (fact sheet)[3]7Hour 18 to 24Untreated, respiratory failure and death can occurthis early.World Health Organization: Plague (fact sheet)[3]8Day 2 to 4Untreated, 98% die. Pooled rate, 95% confidenceinterval 73 to 100%.Salam AP, Rojek AM, Cai E, Raberahona M, Horby P: Deaths Associated with Pneumonic Plague, 1946-2017[4]9Hour 48 of treatmentDroplet precautions can end once the patient has hadantimicrobials for at least 48 hours and hasimproved clinically.Nelson CA, Meaney-Delman D, Fleck-Derderian S, Cooley KM, Yu PA, Mead PS: Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response[10]Pneumonic plague, hour 0 to day 4Hour 01Hour 242Day 1 to 33Onset4Within hours5Within 24 hof onset6Hour 18 to247Day 2 to 48Hour 48 oftreatment91Hour 0Exposure. Inhaling respiratorydroplets from a person oranimal with pneumonic plague.WHO advises keeping more than2 metres from a coughingperson.World Health Organization: Plague (questions and answers)[6]European Centre for Disease Prevention and Control: Facts about plague[2]2Hour 24Symptoms can already start.Incubation can be as short as24 hours.World Health Organization: Plague (fact sheet)[3]3Day 1 to 3The full incubation range forthe pneumonic form. A patientcan still be symptom free.European Centre for Disease Prevention and Control: Facts about plague[2]Public Health Agency of Canada: Pathogen Safety Data Sheet: Yersinia pestis[7]4OnsetFever, headache, weakness,then a rapidly developingpneumonia.Centers for Disease Control and Prevention: Signs and Symptoms of Plague[1]5Within hoursChest pain, cough, difficultybreathing, bloody or waterysputum.European Centre for Disease Prevention and Control: Facts about plague[2]World Health Organization: Plague (questions and answers)[6]6Within 24 h of onsetThe treatment window.Antimicrobials should be giveninside it, and recovery ratesare high when they are.Centers for Disease Control and Prevention: Guidance for Responding to a Plague Bioterrorism Event[9]World Health Organization: Plague (fact sheet)[3]7Hour 18 to 24Untreated, respiratory failureand death can occur thisearly.World Health Organization: Plague (fact sheet)[3]8Day 2 to 4Untreated, 98% die. Pooledrate, 95% confidence interval73 to 100%.Salam AP, Rojek AM, Cai E, Raberahona M, Horby P: Deaths Associated with Pneumonic Plague, 1946-2017[4]9Hour 48 of treatmentDroplet precautions can endonce the patient has hadantimicrobials for at least 48hours and has improvedclinically.Nelson CA, Meaney-Delman D, Fleck-Derderian S, Cooley KM, Yu PA, Mead PS: Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response[10]

Incubation can be as short as 24 hours, and death can follow 18 hours after symptoms start.

How it spreads

56211
How it spreadsInfected rodent flea biteCenters for Disease Control and Prevention: About Plague[5]BubonicHandling or skinning an infected animalCenters for Disease Control and Prevention: About Plague[5]He Z, Wei B, Zhang Y, et al: Distribution and Characteristics of Human Plague Cases and Yersinia pestis Isolates from 4 Marmota Plague Foci, China, 1950-2019[11]Bubonic or pneumonicInhaling respiratory droplets within 2 metresWorld Health Organization: Plague (questions and answers)[6]PneumonicUntreated bubonic or septicaemic plague can seed thelungs and become pneumonic.European Centre for Disease Prevention and Control: Facts about plague[2]Only pneumonic plague spreads person to person,through respiratory particles.World Health Organization: Plague (questions and answers)[6]How it spreadsInfected rodent flea biteCenters for Disease Control and Prevention: About Plague[5]BubonicHandling or skinning an infected animalCenters for Disease Control and Prevention: About Plague[5]He Z, Wei B, Zhang Y, et al: Distribution and Characteristics of Human Plague Cases and Yersinia pestis Isolates from 4 Marmota Plague Foci, China, 1950-2019[11]Bubonic or pneumonicInhaling respiratory droplets within 2metresWorld Health Organization: Plague (questions and answers)[6]PneumonicUntreated bubonic or septicaemic plague can seed the lungs and become pneumonic.European Centre for Disease Prevention and Control: Facts about plague[2]Only pneumonic plague spreads person to person, through respiratory particles.World Health Organization: Plague (questions and answers)[6]

Three routes in from animals, and one route between people.

  • Bubonic plague does not normally pass between people unless flea populations are very high.2
  • Hunting, trapping, skinning and handling meat are the usual direct contact routes.11

When to seek care

6152
When to seek careWHOContact a health provider immediately on suddensymptoms of fever, chills, painful and inflamedlymph nodes, or shortness of breath.World Health Organization: Plague (questions and answers)[6]CDCSeek immediate medical attention for these symptoms,because prompt treatment with the correctmedications is critical to prevent complications ordeath.Centers for Disease Control and Prevention: Signs and Symptoms of Plague[1]CDCPlague can be cured with antibiotics, but treatmentmust be given quickly.Centers for Disease Control and Prevention: About Plague[5]ECDCSuspect plague on an influenza like onset thatworsens rapidly, with chest pain, sputum anddifficulty breathing.European Centre for Disease Prevention and Control: Facts about plague[2]When to seek careWHOContact a health provider immediately onsudden symptoms of fever, chills, painful andinflamed lymph nodes, or shortness of breath.World Health Organization: Plague (questions and answers)[6]CDCSeek immediate medical attention for thesesymptoms, because prompt treatment with thecorrect medications is critical to preventcomplications or death.Centers for Disease Control and Prevention: Signs and Symptoms of Plague[1]CDCPlague can be cured with antibiotics, buttreatment must be given quickly.Centers for Disease Control and Prevention: About Plague[5]ECDCSuspect plague on an influenza like onset thatworsens rapidly, with chest pain, sputum anddifficulty breathing.European Centre for Disease Prevention and Control: Facts about plague[2]

Every line below is the authority's own wording.

Sources

Every figure above links to its row here. WHO and CDC pages are the current published versions; each peer-reviewed paper carries its DOI.

  1. [1]

    CDC Centers for Disease Control and Prevention

    Signs and Symptoms of Plague

    Accessed 2026-10-07

    cdc.gov ↗ (opens in a new tab)
  2. [2]

    ECDC European Centre for Disease Prevention and Control

    Facts about plague

    Accessed 2026-10-07

    ecdc.europa.eu ↗ (opens in a new tab)
  3. [3]

    WHO World Health Organization

    Plague (fact sheet)

    Last updated 29 September 2026 · Accessed 2026-10-07

    who.int ↗ (opens in a new tab)
  4. [4]

    Peer reviewed Salam AP, Rojek AM, Cai E, Raberahona M, Horby P

    Deaths Associated with Pneumonic Plague, 1946-2017

    Emerging Infectious Diseases 2020;26(10):2432-2434. Systematic review of 1,107 patients across 44 articles, with antimicrobial data for 108 confirmed or probable cases. · Accessed 2026-10-07

    doi.org/10.3201/eid2610.191270 ↗ (opens in a new tab)
  5. [5]

    CDC Centers for Disease Control and Prevention

    About Plague

    Accessed 2026-10-07

    cdc.gov ↗ (opens in a new tab)
  6. [6]

    WHO World Health Organization

    Plague (questions and answers)

    Accessed 2026-10-07

    who.int ↗ (opens in a new tab)
  7. [7]

    PHAC Public Health Agency of Canada

    Pathogen Safety Data Sheet: Yersinia pestis

    Accessed 2026-10-07

    canada.ca ↗ (opens in a new tab)
  8. [8]

    Peer reviewed Bourner J, Dwivedi R, Randremanana RV, et al

    A prospective cohort study to describe the morphology of buboes in patients with bubonic plague using ultrasound imaging

    PLoS Neglected Tropical Diseases 2026;e0014133. Bubo size and morphology did not correlate with clinical status. · Accessed 2026-10-07

    doi.org/10.1371/journal.pntd.0014133 ↗ (opens in a new tab)
  9. [9]

    CDC Centers for Disease Control and Prevention

    Guidance for Responding to a Plague Bioterrorism Event

    Accessed 2026-10-07

    cdc.gov ↗ (opens in a new tab)
  10. [10]

    CDC Nelson CA, Meaney-Delman D, Fleck-Derderian S, Cooley KM, Yu PA, Mead PS

    Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response

    MMWR Recommendations and Reports 2021;70(RR-3):1-27. Published 16 July 2021. The authoritative source for doses, which this site does not reproduce. · Accessed 2026-10-07

    cdc.gov ↗ (opens in a new tab)
  11. [11]

    Peer reviewed He Z, Wei B, Zhang Y, et al

    Distribution and Characteristics of Human Plague Cases and Yersinia pestis Isolates from 4 Marmota Plague Foci, China, 1950-2019

    Emerging Infectious Diseases 2021;27(10):2544-2553. Source for hunting, trapping, skinning and meat handling as the direct-contact exposure routes. · Accessed 2026-10-07

    doi.org/10.3201/eid2710.202239 ↗ (opens in a new tab)

Antibiotics, timing, prophylaxis and isolation are on the treatment page.