Yersinia pestis infection history and symptoms: Difference between revisions

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| style="padding: 5px 5px; background: #DCDCDC;" |'''Bubonic Plague'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''Bubonic Plague'''
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*Primary: ''Y. pestis'' bacteremia after a cutaneous exposure
*Fleabite or exposure to animals infected by fleabite, such as squirrels, rabbits, dogs, and cats.
*Secondary: Spread of bacteria following a localized plague, that may also be bubonic or pneumonic.
*Direct exposure of infected skin or mucus membranes
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Symptoms generally start 2-6 days after exposure:
*Papules, vesicles, pustules, ulcers, or eschar at inoculation site surrounded by erythematous, edematous and adherent skin
*Papules, vesicles, pustules, ulcers, or eschar at inoculation site surrounded by erythematous, edematous and adherent skin
*Abrupt onset of headache, chills, fever, and malaise
*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.
*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.
| style="padding: 5px 5px; background: #F5F5F5;" |Symptoms of complications may also arise. The most common complications are:
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Symptoms of complications may also arise. The most common complications are:
*Septicemia
*Septicemia
*Pneumonia
*Pneumonia
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*Secondary: Local infection by bubonic or pneumonic plague followed by infection spread
*Secondary: Local infection by bubonic or pneumonic plague followed by infection spread
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Usually affects patients older than 60 years of age. Characteristically, there is absence of lymphadenopathy, which differentiates it from bubonic plague.
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Usually affects patients older than 60 years of age
Characteristically, there is absence of lymphadenopathy
Signs and symptoms of gram-negative sepsis may predominate:
Signs and symptoms of gram-negative sepsis may predominate:
*Fever
*Fever
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| style="padding: 5px 5px; background: #DCDCDC;" |'''Pneumonic Plague'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''Pneumonic Plague'''
| style="padding: 5px 5px; background: #F5F5F5;" | Aerosol
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Respiratory symptoms are the hallmark of pneumonic plague:
*Primary: Ingestion or inhalation of ''Y. pestis''
*Secondary: Infection with another plague type that eventually involves the lungs
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Respiratory symptoms causing a virulent pneumonia are the hallmark of pneumonic plague:
*Chest pain
*Chest pain
*Dyspnea
*Dyspnea
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*Tachypnea
*Tachypnea
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*Septicemia
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Revision as of 16:15, 25 July 2014

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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 plagues and their corresponding clinical features.

Various Types of Plagues and Clinical Features[1]
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

Pneumonic Plague


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

Pneumonic Plague

References

  1. Koirala J (2006). "Plague: disease, management, and recognition of act of terrorism". Infect Dis Clin North Am. 20 (2): 273–87, viii. doi:10.1016/j.idc.2006.02.004. PMID 16762739.
  2. Info taken from "Harrison's Principles of Internal Medicine 16th Edition"
  3. Info taken from "Harrison's Principles of Internal Medicine 16th Edition"


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