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Pneumonic plague is the most virulent and least common form of plague, caused by the bacterium yersinia pestis. Typically, pneumonic form is due to a secondary spread from advanced infection of an initial bubonic form. Primary pneumonic plague results from inhalation of aerosolized infective droplets and can be transmitted from human to human without involvement of fleas or animals. Untreated pneumonic plague has a very high case-fatality ratio. Pneumonic plague can be caused in two ways primary, which results from the inhalation of aerosolised plague bacteria, or secondary, when septicemic plague spreads into lung tissue from the bloodstream. Pneumonic plague is not vector-borne like bubonic plague, instead it can be spread from person to person. There have been cases of pneumonic plague resulting from the dissection or handling of contaminated animal tissue. The most apparent symptom of pneumonic plague is coughing, often with hemoptysis. With pneumonic plague, the first signs of illness are fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. The pneumonia progresses for 2 to 4 days and may cause respiratory failure and shock. Without early treatment, patients may die.
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