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FINDINGS: The three types of plague are bubonic, septicemic, and pneumonic. In bubonic plague, some patients have a papule, pustule, or ulcer at the site of the flea bite. Some distinguishing features of bubonic plague versus other causes of acute lymphadenitis are rapid onset, severe systemic symptoms, exquisite tenderness of buboes, and absence of cellulitis or lymphangitis. Secondary pneumonic plague develops in some cases with a grave prognosis. [Guerrant, p. 476-7] Some patients have prominent gastrointestinal symptoms including nausea, vomiting, diarrhea, and abdominal pain. [PPID, p. 226] Other findings are delirium, tachycardia, and lymphangitis. Complications of septicemia include pneumonia, meningitis, cyanosis, purpura, shock, and disseminated intravascular coagulation (DIC). [CCDM, p. 406-12; Current Consult, p. 750] Platelet counts are usually normal, but are low in the presence of DIC. [ID, p. 1457] EPIDEMIOLOGY: Cats and dogs may carry rodent fleas into households. Plague bacilli can also be transmitted by handling the tissues of infected animals and, rarely, by inhaling droplets from infected patients or animals with plague pneumonia or pharyngitis. Natural reservoirs are wild rodents (especially ground squirrels); also rabbits, hares, cats, and wild carnivores may become infected. PREVENT AND TREAT: Antibiotic treatment is highly effective if begun early. The vaccine is no longer commercially available. [CCDM] |
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