Humans can be infected through the bite of infected vector fleas unprotected contact with infectious bodily fluids or contaminated materials, and the inhalation of respiratory droplets/small particles from a patient with pneumonic plague. It is transmitted between animals through fleas. Currently, the three most endemic countries are the Democratic Republic of the Congo, Madagascar, and Peru. Plague can be a very severe disease in people, with a case-fatality ratio of 30% to 60% for the bubonic type, and is always fatal for the pneumonic kind when left untreated. Bubonic plague is the most common form and is characterized by painful swollen lymph nodes or ‘buboes’. There are two main clinical forms of plague infection: bubonic and pneumonic. Plague is caused by the bacteria Yersinia pestis, a zoonotic bacterium usually found in small mammals and their fleas.
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