Plague (Yersinia pestis)

Reportable by Laboratories and Providers

About this Reportable Disease

Infectious agent: Yersinia pestis

Description of illness:  Plague is a disease that affects humans and other mammals, caused by the bacterium, Yersinia pestis. Humans usually contract plague after being bitten by a rodent flea that is carrying the plague bacterium or by handling an animal infected with plague. Antibiotics are effective in treating plague; however without prompt treatment, the disease can cause serious illness or death.

Yersinia pestis

TEST NAME Yersina Pestis  
DISEASE/DISORDER Plague  
ALTERNATE NAME(S) Name  
METHODOLOGY

LRN-B Yersinia pestis PCR/ 7500DX

  
SPECIAL INSTRUCTIONS
  • Isolate Submission REQUIRED. 
  • Contact Bioterrorism laboratory before submission. 
  
ORDERING INFORMATION

Lab Web Portal

TDH DLS Requisition:  PH-4263 Clinical Select Agent Rule-Out Submission Requisition

  

Specimen Requirements

Patient Preparation
  • None
  
Specimen Collection
  • Acceptable Specimen Sources/Type(s) for Submission

-  Culture Isolate

-  Blood

-  Aspirated fluids

- Tissue

- Respiratory samples

  
Specimen Labeling
  • Specimen should be labeled with at least two unique patient identifiers along with specimen source and match accompanying test order.
  
Specimen Processing
  • Contact Bioterrorism laboratory prior to shipment to determine appropriate specimen handling based on LRN protocols.
  
Specimen Storage and Preservation
  • Contact Bioterrorism laboratory prior to shipment to determine appropriate specimen handling based on LRN protocols.
  
Specimen Transport
  • Contact Bioterrorism laboratory prior to shipment to determine appropriate specimen handling based on LRN protocols.
  • All infectious substance shipments must conform to U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR 49 C.F.R. Parts 171-180). 
  
Specimen Acceptability and Rejection
  • Contact Bioterrorism laboratory prior to shipment to determine appropriate specimen handling based on LRN protocols.
  
Testing Location
  • Nashville
  • Knoxville
  

Laboratory Reporting

Reporting requirements apply to all laboratories located within Tennessee as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2025 are indicated and there are several ways laboratories can report results to TDH.

 

Information about this Reportable Disease for Healthcare Providers

Clinical Summary

  • Plague is a serious infectious disease caused by the bacterium Yersinia pestis, typically transmitted through bites from infected fleas or contact with infected animals.
  • It can occur in the western United States and other parts of the world where the bacterium circulates in wild rodents.
  • Plague has three main forms: bubonic (swollen lymph nodes), septicemic (blood infection), and pneumonic (lung infection), each with varying severity.
  • Symptoms include sudden fever, chills, headache, weakness, and, depending on type, swollen lymph nodes, abdominal pain, or severe pneumonia.
  • Early treatment with antibiotics is critical to prevent serious illness or death, as plague can progress rapidly if untreated.

Healthcare Provider Reporting

Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.

Providers must report cases of all diseases and conditions listed through one of these methods:

• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857

• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.

• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting. 

• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link. 

Information about this Reportable Disease for the Public

What It Is

Plague is a potentially life-threatening disease caused by the bacterium Yersinia pestis.

Humans typically become infected through the bite of an infected rodent flea or by handling an infected animal.

Plague occurs naturally in areas of the western United States, where it circulates among wild rodents and other animals.

It can be cured with antibiotics, but treatment must be given promptly to prevent serious illness or death.

Plague is infamous for killing millions of people in Europe during the Middle Ages

Types

Bubonic plague: The most common form, characterized by the sudden onset of fever, chills, headache, fatigue, and swollen, painful lymph nodes (buboes).

Septicemic plague: Occurs when the infection spreads to the bloodstream, leading to fever, chills, abdominal pain, shock, and possibly bleeding into the skin and other organs.

Pneumonic plague: A rare but severe form that affects the lungs and can spread from person to person through respiratory droplets.

Primary pneumonic plague: Develops when Y. pestis infects the lungs directly, often following inhalation of infectious droplets.

Secondary pneumonic plague: Develops when bacteria spread from the bloodstream to the lungs.

Signs and Symptoms

Bubonic plague: Sudden onset of fever, chills, headache, fatigue, and swollen, painful lymph nodes (buboes).

Septicemic plague: Fever, chills, abdominal pain, shock, and possibly bleeding into the skin and other organs.

Pneumonic plague: Fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, and cough.

Primary pneumonic plague: Fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, and cough.

Secondary pneumonic plague: Symptoms similar to primary pneumonic plague, often following septicemic spread.

Treatment

Plague can be cured with antibiotics, but treatment must be given promptly to prevent serious illness or death.

Gentamicin and fluoroquinolones are first-line treatments in the United States.

Duration of treatment is 10 to 14 days, but treatment can be extended for patients with ongoing fever or other concerning signs.

Patients can be treated with intravenous or oral antimicrobials, depending on severity of illness and other clinical factors.

Early diagnosis and prompt antibiotic treatment are essential for reducing the risk of complications and death.

Other Resources

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World Health Organization: Plague

This Page Last Updated: March 25, 2026 at 8:53 PM