Yersinia pestis infection history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editors-In-Chief: Esther Lee, M.A.

Overview

The typical sign of the most common form of human plague is a swollen and very tender lymph gland, accompanied by pain. The swollen gland is called a "bubo." Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2 to 6 days after being infected.

History and Symptoms

The plague may have any of 3 classic presentations:

• Bubonic plague
• Septicemic plague
• Pneumonic plague

The following table compares the various types of plague and their corresponding clinical features.

Various Types of Plague and Clinical Features

Subtype	Mode of Transmission	Manifestations	Complications
Bubonic Plague	Fleabite or exposure to animals infected by fleabite, such as squirrels, rabbits, dogs, and cats. Direct exposure of infected skin or mucus membranes	Symptoms generally start 2-6 days after exposure: Papules, vesicles, pustules, ulcers, or eschar at inoculation site surrounded by erythematous, edematous and adherent skin Abrupt onset of headache, chills, fever, and malaise 1-10 cm painful and tender lymph nodes, called buboes, that appear after 24 hours. Lymphadenopathy may involve any site (superficial lymph nodes such as inguinal, axillary, popliteal, supraclavicular, cervical, epitrochlear, or even deeper lymph nodes such as intra-abdominal or intra-thoracic). Buboes may become fluctuant and suppurative.	Symptoms of complications may also arise. The most common complications are: Septicemia Pneumonia Meningitis
Septicemic Plague	Primary: Y. pestis bacteremia after cutaneous exposure Secondary: Local infection by bubonic or pneumonic plague followed by infection spread	Usually affects patients older than 60 years of age. Characteristically, there is absence of lymphadenopathy, which differentiates it from bubonic plague. Signs and symptoms of gram-negative sepsis may predominate: Fever Tachypnea Tachycardia Altered mental status Hypotension	Black death: Gangrene of distal upper and lower extremities and tip of the nose due to small vessel thrombosis Disseminated intravascular coagulopathy (DIC) Adult respiratory distress syndrome (ARDS) Meningitis Pneumonia Hepatic or splenic abscess Endophthalmitis Generalized lymphadenopathy -
Pneumonic Plague	Primary: Ingestion or inhalation of Y. pestis Secondary: Infection with another plague type that eventually involves the lungs	Respiratory symptoms causing a virulent pneumonia are the hallmark of pneumonic plague: Chest pain Dyspnea Cough Hemoptysis that starts as blood-tinged sputum, but rapidly develops into bloody mucupurulent sputum Tachypnea	Septicemia -

^{Adapted from Koirala et al. Plague: disease, management, and recognition of act of terrorism. Infect Dis Clin N Am.2006;20:273-87}

Bubonic Plague

• Incubation period of 2–6 days, when the bacteria is actively replicating.
• Universally a general lack of energy
• Fever
• Headache and chills occur suddenly at the end of the incubation period
• Swelling of lymph nodes resulting in buboes, the classic sign of bubonic plague. The inguinal nodes are most frequently affected ("boubon" is Greek for "groin.")

Septicemic Plague

• Hypotension
• Hepatosplenomegaly
• Delirium
• Seizures in children
• Shock
• Universally a general lack of energy
• Fever
• Symptoms of bubonic or pneumonic plague are not always present

Pneumonic Plague

• Fever
• Chills
• Coughing
• Chest pain
• Dyspnea
• Hemoptysis
• Lethargy
• Hypotension
• Shock
• Symptoms of bubonic or septicemic plague are not always present

Bubonic Plague

• Incubation period of 2–6 days, when the bacteria is actively replicating.
• Universally a general lack of energy
• Fever
• Headache and chills occur suddenly at the end of the incubation period
• Swelling of lymph nodes resulting in buboes, the classic sign of bubonic plague. The inguinal nodes are most frequently affected ("boubon" is Greek for "groin.")

Septicemic Plague

• Hypotension
• Hepatosplenomegaly
• Delirium
• Seizures in children
• Shock
• Universally a general lack of energy
• Fever
• Symptoms of bubonic or pneumonic plague are not always present

Pneumonic Plague

• Fever
• Chills
• Coughing
• Chest pain
• Dyspnea
• Hemoptysis
• Lethargy
• Hypotension
• Shock
• Symptoms of bubonic or septicemic plague are not always present

References

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