Plague (cont.)

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What are plague symptoms and signs?

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The symptoms of plague can be progressive; however, most investigators break the symptoms into three different groups because plague is often described in three types: bubonic, septicemic, and pneumonic. A patient can also present with the symptoms of only one type of plague. Untreated plague may show progressive symptoms that can overlap; however, the following will describe those symptoms and signs that predominate during the three general types of plague:

  • Bubonic: In about three to seven days, lymph nodes become swollen, tender, and are termed buboes (the term bubonic is derived from buboes) and the patient may also develop fever, chills, and weakness. Nodes and other body areas may develop a black color.
  • Septicemic: In general, septicemic plague patients do not develop buboes; instead symptoms may include fever, chills, and weakness, bleeding under the skin, abdominal pain, and septic shock with low blood pressure. Septicemic plague may develop in about one to seven days after exposure.
  • Pneumonic: In about one to three days after the person is exposed to airborne droplets that contain Y. pestis, shortness of breath, cough (sometimes with bloody sputum), and chest pain quickly develop along with weakness, fever, and headaches.

Untreated bubonic plague may progress and produce symptoms of both septicemic and pneumonic plague, while septicemic plague may progress to produce pneumonic plague. However, pneumonic plague is the most serious and lethal form of plague, and while the patient may develop septicemic symptoms, the pneumonic symptoms are the most serious. Nonetheless, all three plague types can be fatal to a patient.

How is plague diagnosed?

The history and physical exam is an important first step in the diagnosis of plague. The patient's exposure to animals (and the fleas that accompany them) or exposure to humans that have plague or the symptoms of plague, or have visited or reside in a plague-endemic area can help trigger the medical caregivers' ability to do further tests for plague. In addition, if buboes develop in about three to seven days after exposures listed above, bubonic plague may be presumptively diagnosed. Unless septicemic or pneumonic plague develop directly from the bubonic form, the presumptive diagnosis is somewhat more difficult to make; sometimes because plague is seen so infrequently by many doctors. However, a good patient history can help make a more timely presumptive diagnosis. In addition, bleeding under the skin and other septicemic symptoms may be helpful. Laboratory tests are usually based on the detection of the F1 antigen of Y. pestis and can provide both a presumptive and definitive diagnosis of plague.

Definitive diagnosis of plague has also been done by PCR tests to detect the genetic material of Y. pestis antigens in animal, flea, and human tissues.
Medically Reviewed by a Doctor on 10/30/2013

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