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Plague is caused by the bacterium Yersinia pestis. The incubation period is typically 1‐6 days, with non‐specific initial signs and symptoms, including fever, chills, sore throat, malaise, and headache. Tender, swollen, warm, and suppurative lymph nodes, mainly in the inguinal area, often follow. Patients infected with the plague may progress to septicemia, meningitis, pneumonia, or shock. Untreated plague has a case‐fatality rate of 50‐90%; if treated, mortality is 15%.

Plague is transmitted to humans by bites, scratches, respiratory droplets, or by direct skin contact. Bites from infected rat fleas are the most frequent source of transmission, but bites or scratches from cats may also transmit plague. Direct contact with tissue or body fluids of a plague‐infected sick or dead animal can lead to transmission to humans through a break in the skin [46].

For patients with pneumonic plague, strict isolation is indicated with precautions against airborne spread until 48 hours after the start of antibiotic therapy. Close contacts of patients infected with pneumonic plague should receive chemoprophylaxis and be placed under surveillance for 7 days. Articles soiled with sputum or purulent discharges should be disinfected.

Yersinia pestis could be used as a potential biological weapon leading to pneumonic plague [47]. In case of deliberate use as a biological weapon, plague bacilli would be transmitted via aerosolized airborne droplets. Many patients presenting with fever and cough, particularly hemoptysis in a fulminant course with high case fatality, should raise suspicions for a biological weapon [48–50].