Yersinia pestis infection physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Yazan Daaboul; Serge Korjian


Apart from the presence of buboes, which are tender lymph nodes in patients infected with bubonic plague, the physical examination findings are not specific to plague. Nonetheless, physical examination is crucial to evaluate for the presence of target organ damage or the progression and worsening of infection burden in these patients.[1]

Physical Examination

Buboes, which are fixed tender lymphadenopathy in patients with bubonic plague, are characteristic findings on physical examination.[1] Otherwise, patients with plague infection generally have non-specific physical examination findings. Nonetheless, physical examination is key in all cases of plague for the evaluation of the patient's clinical picture and monitoring for clinical response.[1]

General Appearance

Patients infected with plague are generally toxic-looking.

Vital Signs



  • Papules, pustules, ulcers, or vesicles surrounded by local erythema at site of infection
  • Fixed tender lymphadenopathy of 1-10 cm in diameter in bubonic plague that may be present anywhere: axillary, cervical, postauricular, inguinal, epitrochlear, or popliteal. Lymph nodes may demonstrate fluctuance, suppuration, and may eventually drain.


  • Auscultation may be minimal despite worsening infectious burden
  • Dullness to percussion due to segmental pulmonary consolidation
  • Decreased breath sounds over affected area



  • Black gangrenous distal upper and lower extremities (shown below)


  1. 1.0 1.1 1.2 "Plague". Centers for Disease Control and Prevention. CDC. Jun 13 2012. Retrieved Jul 25 2014. Check date values in: |accessdate=, |date= (help)
  2. 2.0 2.1 2.2 2.3 "Public Health Image Library (PHIL), Centers for Disease Control and Prevention".

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