Summary
Definition
History and exam
Key diagnostic factors
- constitutional symptoms
- lymphadenitis (bubonic plague)
- hemoptysis (pneumonic plague)
- diarrhea (yersiniosis)
- abdominal pain (yersiniosis)
Other diagnostic factors
- pleuritic chest pain (pneumonic plague)
- dyspnea (pneumonic plague)
Risk factors
- exposure to fleas (plague)
- residence in, or travel to, an endemic area (plague)
- contact with infected animals (plague)
- bioterrorism (plague)
- young children (yersiniosis)
- consumption of raw or undercooked pork products (yersiniosis)
- exposure to people with plague (plague)
- iron-overload syndromes (yersiniosis)
- chronic liver disease, diabetes, alcoholism (yersiniosis)
Diagnostic tests
1st tests to order
- blood culture (plague)
- bubo aspirate culture (bubonic plague)
- sputum culture (pneumonic plague)
- cerebrospinal fluid culture (septicemic plague)
- throat swab specimen culture (pharyngeal plague)
- antigen detection (plague)
- WBC count (plague)
- chest x-ray (pneumonic plague)
- stool culture (yersiniosis)
Tests to consider
- serology (plague or yersiniosis)
- polymerase chain reaction (plague)
Treatment algorithm
pneumonic or septicemic plague: nonpregnant adults and children
bubonic or pharyngeal plague: nonpregnant adults and children
pneumonic, septicemic, bubonic, or pharyngeal plague: pregnant
meningeal plague
yersiniosis
Contributors
Authors
John Williams, MRCP, DTM&H, Dip HIV Med
Consultant Infectious Diseases Physician
Department of Infection and Travel Medicine
The James Cook University Hospital
Middlesbrough
UK
Disclosures
JW declares that he has no competing interests.
Peer reviewers
Vladimir L. Motin, PhD
Professor
Pathology/Microbiology and Immunology
University of Texas Medical Branch
Galveston
TX
Disclosures
VLM declares that he has no competing interests.
Waleed Javaid, MD, FACP, FIDSA
Associate Professor
Medical Director of Infection Control
Infectious Disease
Department of Medicine
SUNY Upstate Medical University
Syracuse
NY
Disclosures
WJ declares that he has no competing interests.
Alistair Leanord, BSc, MBChB, MD, DTM&H, FRCPath
Consultant Microbiologist
Microbiology Department
Southern General Hospital
Glasgow
UK
Disclosures
AL declares that he has no competing interests.
Janak Koirala, MD
Associate Professor of Medicine
Division of Infectious Diseases
Department of Internal Medicine
Southern Illinois University School of Medicine
Springfield
IL
Disclosures
JK declares that he has no competing interests.
Differentials
- Gram-negative sepsis
- Bacterial pneumonia
- Cat scratch disease
More DifferentialsGuidelines
- CDC Yellow Book: health information for international travel - plague
- CDC Yellow Book: health information for international travel - yersiniosis
More GuidelinesPatient information
Appendicitis
Diarrhea in adults
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