Cause

An Oriental rat flea (Xenopsylla cheopis) infected with the plague bacterium (Yersinia pestis), which
appears as a dark mass in the gut. The foregut of this flea is blocked by a Y. pestis biofilm; when the
flea attempts to feed on an uninfected host, Y. pestis from the foregut is regurgitated into the
wound, causing infection.

Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an
infected flea, Xenopsylla cheopis (the Oriental rat flea).[13] Several flea species carried the
bubonic plague, such as Pulex irritans (the human flea), Xenopsylla cheopis, and
Ceratophyllus fasciatus.[13] Xenopsylla cheopis was the most effective flea species for
transmittal.[13] In very rare circumstances, as in septicemic plague, the disease can be
transmitted by direct contact with infected tissue or exposure to the cough of another human.
The flea is parasitic on house and field rats and seeks out other prey when its rodent hosts die.
The bacteria remain harmless to the flea, allowing the new host to spread the bacteria. Rats
were an amplifying factor to bubonic plague due to their common association with humans as
well as the nature of their blood.[14] The rat's blood allowed the rat to withstand a major
concentration of the plague.[14] The bacteria form aggregates in the gut of infected fleas and
this results in the flea regurgitating ingested blood, which is now infected, into the bite site of
a rodent or human host. Once established, bacteria rapidly spread to the lymph nodes and
multiply. The fleas that transmit the disease only directly infect humans when the rat
population in the area is wiped out from a mass infection.[15] Furthermore, in areas of a large
population of rats, the animals can harbor low levels of the plague infection without causing
human outbreaks.[14] With no new rat inputs being added to the population from other areas,
the infection would only spread to humans in very rare cases of overcrowding.[14]
Signs and symptoms

Necrosis of the nose, the lips, and the fingers and residual bruising over both forearms in a person
recovering from bubonic plague that disseminated to the blood and the lungs. At one time, the
person's entire body was bruised.

After being transmitted via the bite of an infected flea, the Y. pestis bacteria become localized
in an inflamed lymph node, where they begin to colonize and reproduce. Infected lymph
nodes develop hemorrhages, which result in the death of tissue.[16]Y. pestis bacilli can resist
phagocytosis and even reproduce inside phagocytes and kill them. As the disease progresses,
the lymph nodes can hemorrhage and become swollen and necrotic. Bubonic plague can
progress to lethal septicemic plague in some cases. The plague is also known to spread to the
lungs and become the disease known as the pneumonic plague. Symptoms appear 2–7 days
after getting bitten and they include:[13]

 Chills
 General ill feeling (malaise)
 High fever >39 °C (102.2 °F)
 Muscle cramps[16]
 Seizures
 Smooth, painful lymph gland swelling called a bubo, commonly found in the groin, but may
occur in the armpits or neck, most often near the site of the initial infection (bite or scratch)
 Pain may occur in the area before the swelling appears
 Gangrene of the extremities such as toes, fingers, lips, and tip of the nose. [17]
 Buboes

The best-known symptom of bubonic plague is one or more infected, enlarged, and painful
lymph nodes, known as buboes. Buboes associated with the bubonic plague are commonly
found in the armpits, upper femoral, groin, and neck region. symptoms include heavy
breathing, continuous vomiting of blood (hematemesis), aching limbs, coughing, and extreme
pain caused by the decay or decomposition of the skin while the person is still alive.
Additional symptoms include extreme fatigue, gastrointestinal problems, spleen
inflammation, lenticulae (black dots scattered throughout the body), delirium, coma, organ
failure, and death.[18] Organ failure is a result of the bacteria infecting organs through the
bloodstream.[13] Other forms of the disease include septicemic plague and pneumonic plague
in which the bacterium reproduces in the person's blood and lungs respectively.[citation needed]