Animals Involved
Rodents (eg, squirrels, prairie dogs, rats) and lagomorphs (pikas in Asia) are main reservoir; many mammals can be incidental hosts; cats and wild felids especially susceptible
Known Distributions
Foci in North and South America, Asia, Middle East, and Africa
Probable Means of Spreading
Flea bites, aerosols, handling infected animals or tissues (contact with broken skin or mucous membranes), bites or scratches, eating uncooked infected tissues
Clinical Manifestations in People
Febrile flulike syndrome with swollen, very painful draining lymph node(s) (buboes); pneumonia; sepsis can occur in either bubonic or pneumonic form; case fatality rate in untreated 40%–70% (bubonic) to 100% (pneumonic); < 5% mortality if bubonic form treated early