Overview
Physical
- Generally, patients with any form of plague are toxic in appearance. Apprehension and tachycardia are also common.
- All patients are febrile with chills.
- A large bubo is palpable in the groin, axilla, or neck of patients with bubonic plague. The mass is fixed, edematous, exquisitely tender, and often surrounded by an area of erythema.
- Intra-abdominal buboes may be accompanied by tenderness, guarding, and other peritoneal signs. Hepatomegaly can be present.
- Septicemic patients present with tachycardia, tachypnea, and hypotension. Systolic blood pressures are usually less than 100 mm Hg. Differentiation of patients with septicemic plague from patients with other types of gram-negative sepsis is often difficult due to the similarity of signs and symptoms.
- Patients with pneumonic plague manifest cough productive of bloody sputum, tachypnea, and dyspnea.
- Fever and meningismus accompany plague meningitis.
- Patients with plague pharyngitis resemble those with any other form of bacterial pharyngitis or tonsillitis. Large anterior cervical adenopathy may be appreciated.
Causes
- Bacteriology
- Y pestis is a nonmotile, pleomorphic, gram-negative coccobacillus that belongs to the family Enterobacteriaceae. Bipolar staining (giving the appearance of a closed safety pin) can be observed with Giemsa, Wayson, or Wright stains.
- It grows at a wide range of temperatures (4-40ºC) but demonstrates optimal growth at room temperature.
- Both an endotoxin and an exotoxin are produced, adding to the organism's pathogenicity.
- Transmission
- Human infection is usually acquired through the bites of infected rodent fleas. X cheopis, the Oriental rat flea, is the classic vector, but many other species of flea are also capable of transmitting plague. Typically, this form of transmission is common in crowded urban areas.
- Plague can also be contracted from handling infected animals, especially rodents, lagomorphs (eg, rabbits or hares), and domestic cats, or through close contact with patients with pneumonic plague.
- Person-to-person transmission is extremely rare; the last such transmission in the United States was reported in 1925. Person-to-person transmission occurs primarily through droplet exposure from a patient with the pneumonic form of the disease, although direct contact with body fluids can also be infectious.
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