To investigate the clinical characteristics of human pneumonic plague.

The clinical, imaging and laboratory data of a family cluster of pneumonic plague cases in Inner Mongolia from July to August 2023 were analyzed.

The 3 cases with human pneumonic plague were from a same family, and they were treated in several medical institutions on July 31st and August 4th, including 1 male and 2 female, who were 46 years old, 41 years old and 21 years old. There were 1 death, 1 severe case and 1 mild case. Case 1 was the first case with bubonic plague onset and failed to receive timely diagnosis and specific antibiotic treatment, who developed secondary septicemic plague and pulmonary plague, and died 3 days after onset of the disease due to septic shock, disseminated intravascular coagulation (DIC) and multiple organ failure. Case 2 developed and presented as primary pneumonic plague 4 days after exposure, with rapid progression of pulmonary inflammation, respiratory failure and shock. However, due to timely diagnosis, the patient was given 53 g streptomycin combined with moxifloxacin and other treatments, as well as active respiratory and circulatory support, and was cured and discharged after 33 days of treatment. For case 3, the disease was mild and the lung lesions were limited. The early cumulative treatment of 18 g streptomycin combined with moxifloxacin showed rapid improvement.

The key to the successful treatment of pneumonic plague patients is to grasp the epidemiological contact history, the clinical characteristics and evolution of plague, to achieve early diagnosis, early application of specific antibiotics, and carry out sepsis treatment.