Bubonic plague differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There are many diseases that resemble the basic signs and symptoms of bubonic plague. Since bubonic plague has the ability to kill the majority of a population, it is an extremely concerning diagnosis. Given the grave nature of bubonic plague, it is critical to exclude other diagnoses before a final diagnosis of bubonic plague is made.

Differentiating Bubonic Plague from other Diseases

Bubonic Plague

• Streptococcal or staphylococcal adenitis (Staphylococcus aureus, Staphylococcus pyogenes)
  • Purulent or inflamed lesion often noted distal to involved nodes (i.e., pustule, infected traumatic lesion).
  • Involved nodes more likely to be fluctuant.
  • Associated ascending lymphangitis or cellulitis may be present (generally not seen with plague).

• Tularemia (Francisella tularensis)
  • Ulcer or pustule often present distal to involved nodes.
  • Clinical course rarely as fulminant as in plague.
  • Systemic toxicity uncommon.

• Cat scratch fever (Bartonella henselae)
  • History of contact with cats; usually history of cat scratch.
  • Indolent clinical course; progresses over weeks.
  • Primary lesion at site of scratch often present (small papule, vesicle).
  • Systemic toxicity not present.

• Mycobacterial infection, including scrofula (Mycobacterium tuberculosis and other Mycobacterium species)
  • With scrofula, adenitis occurs in cervical region.
  • Usually painless.
  • Indolent clinical course.
  • Infections with species other than M. tuberculosis more likely to occur in immunocompromised patients.

• Lymphogranuloma venereum (Chlamydia trachomatis)
  • Adenitis occurs in the inguinal region.
  • History of sexual exposure 10-30 days previously.
  • Suppuration, fistula tracts common.
  • Although LGV buboes may be somewhat tender, exquisite tenderness usually absent.
  • Although patients may appear ill (headache, fever, myalgias), systemic toxicity not present.

• Chancroid (Haemophilus ducreyi)
  • Adenitis occurs in the inguinal region.
  • Ulcerative lesion present.
  • Systemic symptoms uncommon; toxicity does not occur.

• Primary genital herpes
  • Herpes lesions present in genital area.
  • Adenitis occurs in the inguinal region.
  • Although patients may be ill (fever, headache), severe systemic toxicity not present.

• Primary or secondary syphilis (Treponema pallidum)
  • Enlarged lymph nodes in the inguinal region.
  • Lymph nodes generally painless.
  • Chancre may be noted with primary syphilis.

• Strangulated inguinal hernias
  • Evidence of bowel involvement.