Symptoms

Plague is divided into three main types — bubonic, septicemic and pneumonic — depending on which part of your body is involved. Signs and symptoms vary depending on the type of plague.

Bubonic plague

Bubonic plague is the most common variety of the disease. It's named after the swollen lymph nodes (buboes) that typically develop in the first week after you become infected. Buboes may be:

• Situated in the groin, armpit or neck
• About the size of a chicken egg
• Tender and firm to the touch

Other bubonic plague signs and symptoms may include:

• Sudden onset of fever and chills
• Headache
• Fatigue or malaise
• Muscle aches

Septicemic plague

Septicemic plague occurs when plague bacteria multiply in your bloodstream. Signs and symptoms include:

• Fever and chills
• Extreme weakness
• Abdominal pain, diarrhea and vomiting
• Bleeding from your mouth, nose or rectum, or under your skin
• Shock
• Blackening and death of tissue (gangrene) in your extremities, most commonly your fingers, toes and nose

Pneumonic plague

Pneumonic plague affects the lungs. It's the least common variety of plague but the most dangerous, because it can be spread from person to person via cough droplets. Signs and symptoms can begin within a few hours after infection, and may include:

• Cough, with bloody mucus (sputum)
• Difficulty breathing
• Nausea and vomiting
• High fever
• Headache
• Weakness
• Chest pain

Pneumonic plague progresses rapidly and may cause respiratory failure and shock within two days of infection. Pneumonic plague needs to be treated with antibiotics within a day after signs and symptoms first appear, or the infection is likely to be fatal.

When to see a doctor

If you begin to feel ill and have been in an area where plague has been known to occur, seek immediate medical attention. You'll need treatment with medication to prevent serious complications or death.

In the United States, plague has been transmitted to humans in several western and southwestern states — primarily New Mexico, Arizona, California and Colorado. Worldwide, plague is most common in rural and semirural parts of Africa (especially the African island of Madagascar), South America and Asia.