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Yersinia pestis causes three different forms of plague, bubonic, septicemic, and pneumonic.

Bubonic plague is usually spread by fleas. An infected flea bite allows the bacteria to enter the skin, which then travels through the lymphatic system to the lymph nodes, which become swollen. The infection can also spread by direct contact with infected tissue. Mortality rate is 40-60% if untreated, 1-15% with antibiotics.

Pneumonic plague is caused by inhaling aerosolised bacteria resulting in a lung infection and cough, which allows it to spread from person to person. It can also develop from septicemic plague. Mortality rate is nearly 100% if untreated.

Septicemic plague occurs when the bacteria gets into the bloodstream, usually from the bite of an infected flea, but it can also spread through direct physical contact or through inhaling the bacteria. It is the rarest form of plague. Septicemic plague can develop from pneumonic or bubonic plagues. Mortality rate is nearly 100% if untreated or if treatment is delayed more than 24 hours. Death may occur even before the onset of symptoms.

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