A plague like no other. Beyond the buboes in Thucydides’ accountof the plague of Athens

BackgroundThe Athens Plague (430–427 BCE) was a devastating outbreak during the PeloponnesianWar, described in detail by Thucydides. Although there is ongoing discussion, the specificcause of the epidemic remains undetermined.ObjectivesThis review reexamines the Athenian plague through historical and microbiological lenses,reassessing diagnostic hypotheses and proposing the plausibility of an ancient pneumonicstrain of Yersinia pestis.SourcesWe analyzed Thucydides' original account alongside interdisciplinary literature from classicalstudies, paleopathology, epidemiology, and microbiology. We gathered sources fromPubMed, JSTOR, Google Scholar, and the Perseus Digital Library, covering works from 1634to 2024.ContentThe clinical progression described by Thucydides—fever, conjunctivitis, bloody cough,gastrointestinal symptoms, rash, and high mortality—is compared to the presentations oftyphoid fever, smallpox, epidemic typhus, measles, and plague. This review considersarchaeological and paleogenomic findings, including controversial evidence of Salmonellaenterica and the evolutionary history of Y. pestis. Special emphasis is placed on early strainsof Y. pestis that lacked flea-borne virulence factors but may have caused pneumonic formstransmitted between humans.ImplicationsThe epidemic's significant demographic, political, and social impacts highlight the broaderconsequences of infectious diseases in ancient history. This review emphasizes the necessityof employing a multidisciplinary approach in historical epidemiology and advocates forreassessing pneumonic plague as a likely contributor to the outbreak that occurred inAthens.