b. Bubonic Plague. The primary characteristics of this form of plague is the
enlargement of regional lymph nodes. It is generally caused by the bite of a rat flea
(1) Sign/symptoms. Occasionally, a primary pustule or vesicle may develop
at the site of the fleabite.
In most cases, the first symptoms are fever and prostration
coincident with lymph node enlargement (buboes).
Buboes occur most commonly at the femoral or inguinal nodes,
followed in order of frequency by auxiliary and cervical nodes.
Buboes may be extremely painful.
The infection may remain localized, may
spread throughout the lymphatic system, or may develop into
septicemia with pulmonary involvement (plague pneumonia).
(2) Prognosis. Without treatment, the overall case fatality rate for bubonic
plague is about 30 percent.
c. Primary Pneumonic Plague. This form of the disease is generally caused
by inhalation of plague organisms.
(1) Signs/symptoms. The typical case resembles Iobar pneumonia clinically.
Onset is abrupt, frequently with chills and high fever.
Prostration develops rapidly.
Sputum is produced near the end of the first 24-hour period.
(2) Prognosis. In the absence of treatment, the sputum increases in volume
and becomes frothy and marked with bright blood.
Sputum is literally loaded with plague bacilli.
If not treated, the patient almost invariably dies within 2 to 5 days
from the onset.
d. Primary Septicemic Plague. This form of plague may result from any route
of primary infection.