• Jennifer C. Thompson


On July 25, a 13-year-old girl, who spent considerable time outdoors, handled and then released a wild chipmunk. On July 27, she complained of a sore throat and tenderness in her right groin, and she reportedly had a temperature of 40°C (104°F). On July 29, she saw a physician who noted an oral temperature of 38.3°C (101°F), pharyngeal erythema, tender cervical lymph nodes, and a 1 by 2-cm tender right inguinal lymph node. Laboratory tests, including complete blood count, urinalysis, and throat culture, as well as tests for mononucleosis, were done, and oral penicillin was prescribed. Three days later she was seen again, still febrile and with expanding right inguinal nodes. Her white blood count was 20,500/mm3, and a chest X-ray was normal. Because of her history of residence in a plague-enzootic area, a diagnosis of plague was considered. She was hospitalized and given parenteral streptomycin. By the following morning, she was tachypneic and producing bloody sputum. She appeared moribund. She was transferred to a large, regional medical center where, despite intensive supportive care and therapy with intravenous chloramphenicol, she developed overwhelming sepsis and died on August 2. A chest radiograph taken before death revealed extensive pulmonary infiltrates. Antemortem aspiration of the right inguinal lymph node demonstrated Gram-negative bipolar staining bacilli on Giemsa stain. Both the aspirate and multiple cultures of blood yielded Yersinia pestis. In addition, fluorescent antibody stains for Y. pestis were positive in blood smears, culture material, and pulmonary secretions (1).


Yersinia Pestis Emerg Infect Postexposure Prophylaxis Lymphogranuloma Venereum Pneumonic Plague 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Centers for Disease Control and Prevention. Plague—South Carolina. MMWR 1983;32:417–418.Google Scholar
  2. 2.
    Stedman’s Medical Dictionary, 24th ed. Williams & Wilkins, Baltimore, 1982:1092.Google Scholar
  3. 3.
    The Holy Bible. New International Version. International Bible Society, Colorado Springs, CO, 1984, I Samuel 5:6,9.Google Scholar
  4. 4.
    Aker F. Cecil JC. The influence of disease upon European history. Mil Med 1983;148:441–446.PubMedGoogle Scholar
  5. 5.
    Perry RD, Fetherston JD. Yersinia pestis-etiologic agent of plague. Clin Microbiol Rev 1997;10:35–66.PubMedGoogle Scholar
  6. 6.
    McGovern TW, Friedlander AM. Plague. In: Sidell FR, Takafuji ET, Franz DR, eds. Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare. Borden Institute, Washington DC, 1997, pp. 479–502.Google Scholar
  7. 7.
    Centers for Disease Control and Prevention. Fatal human plague—Arizona and Colorado 1996. MMWR 1997;48:617–620.Google Scholar
  8. 8.
    Centers for Disease Control and Prevention. Human plague—India 1994. MMWR 1994;43:689–691.Google Scholar
  9. 9.
    Ruiz A. Plague in the Americas. Emerg Infect Dis 2001;7:539–540.PubMedCrossRefGoogle Scholar
  10. 10.
    Boisier P, Rahalison L, Rasolomaharo M, et al. Epidemiologic features of four successive annual outbreaks of bubonic plague in Mahajanga, Madagascar. Emerg Infect Dis 2002;8:311–316.PubMedCrossRefGoogle Scholar
  11. 11.
    Gradon JD. Plague pneumonia. Curr Infect Dis Rep 2002;4:244–248.PubMedCrossRefGoogle Scholar
  12. 12.
    Derbes VJ. De Mussis and the great plague of 1348: a forgotten episode ot bacteriological wartare. JAMA 1966;196:179–182.CrossRefGoogle Scholar
  13. 13.
    Wheelis M. Biological warfare at the 1346 siege of Caffa. Emerg Infect Dis 2002;8:971–975.PubMedCrossRefGoogle Scholar
  14. 14.
    Christopher GW, Cieslak TJ, Pavlin JA, et al. Biological warfare: a historical perspective. JAMA 1997;278:412–417.PubMedCrossRefGoogle Scholar
  15. 15.
    Harris S. Japanese biological warfare research on humans: a case study of microbiology and ethics. Ann NY Acad Sci 1992:666:21–52.PubMedCrossRefGoogle Scholar
  16. 16.
    Franz DR, Jahrling PB, Friedlander AM, et al. Clinical recognition and management of patients exposed to biological warfare agents. JAMA 1997;278:399–411.PubMedCrossRefGoogle Scholar
  17. 17.
    Inglesby TV, Dennis DT, Henderson, DA, et al. Plague as a biological weapon: medical and public health management. JAMA 2000; 283:2281–2290.PubMedCrossRefGoogle Scholar
  18. 18.
    WHO. Health Aspects of Chemical and Biological Weapons. World Health Organization, Geneva, 1970, pp. 107–109.Google Scholar
  19. 19.
    Inglesby TV, Grossman R, O’Toole T. A plague on your city: observations from TOPOFF. Clin Infect Dis 2001;32:436–445.PubMedCrossRefGoogle Scholar
  20. 20.
    Smego RA, Frean J, Koornhof HJ. Yersiniosis I: Microbiological and clinicoepidemiological aspects of plague and non-plague Yersinia infections. Eur J Clin Microbiol Infect Dis 1999;18:1–15.PubMedCrossRefGoogle Scholar
  21. 21.
    Palmer D. Plague. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases, 2nd ed. WB Saunders, Philadelphia, 1998, pp. 1568–1575.Google Scholar
  22. 22.
    Butler T. Yersinia species, including plague. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 5th ed. Churchill Livingstone, Philadelphia, 2000, pp. 2406–2414.Google Scholar
  23. 23.
    Christie AB, Chen TH, Elberg SS. Plague in camels and goats: their role in human epidemics. J Infect Dis 1980;141:724–726.PubMedCrossRefGoogle Scholar
  24. 24.
    Gage KL, Dennis DT, Orloski KA, et al. Cases of cat-associated human plague in the western U.S., 1977–1998. Clin Infect Dis 2000;30:892–900.CrossRefGoogle Scholar
  25. 25.
    Sites VR, Poland JD. Mediastinal lymphadenopathy in bubonic plague. Am J Roentgenol Radium Ther Nucl Med 1972;116:567–570.PubMedGoogle Scholar
  26. 26.
    Hull HF, Montes JM, Mann JM. Septicemic plague in New Mexico. J Infect Dis 1987;155:113–118.PubMedCrossRefGoogle Scholar
  27. 27.
    Cleri DJ, Vernaleo JR, Lombardi LJ, et al. Plague pneumonia disease caused by Yersinia pestis. Semin Respir Infect 1997;12:12–23.PubMedGoogle Scholar
  28. 28.
    Aslofrom DJ, Mettler FA, Mann JM. Radiographic manifestations of plague in New Mexico, 1975–1980. Radiology 1981;139:561–565.Google Scholar
  29. 29.
    Florman AL, Spencer RR, Sheward S. Multiple lung cavities in a 12-year-old girl with bubonic plague, sepsis and secondary pneumonia. Am J Med 1986;80:1191–1193.PubMedCrossRefGoogle Scholar
  30. 30.
    Becker TM, Poland JD, Quan TJ, et al. Plague meningitis-a retrospective analysis of cases reported in the United States, 1970–1979. West J Med 1987;147:554–557.PubMedGoogle Scholar
  31. 31.
    Martin AR, Hurtado FP, Plessala RA, et al. Plague meningitis: a report of three cases in children and a review of the problem. Pediatrics 1967;40:610–616.PubMedGoogle Scholar
  32. 32.
    Marshall JD, Quy DV, Gibson FL. Asymptomatic pharyngeal plague infection in Vietnam. Am J Trop Med Hyg 1967;16:175–177.PubMedGoogle Scholar
  33. 33.
    Engelthaler DM, Gage KL, Montenieri JA, et al. PCR detection of Yersinia pestis in fleas: comparison with mouse inoculation. J Clin Microbiol 1999;37:1980–1984.PubMedGoogle Scholar
  34. 34.
    Mann JM, Moskowitz R. Plague and pregnancy: a case report. JAMA 1977;237:1854–1855.PubMedCrossRefGoogle Scholar
  35. 35.
    Wong TW. Plague in a pregnant patient. Trop Doc 1986;16:187–189.Google Scholar
  36. 36.
    Coppes JB. Bubonic plague in pregnancy. J Reprod Med 1980;25:91–95.PubMedGoogle Scholar
  37. 37.
    White ME, Rosenbaum RJ, Canfield TM, et al. Plague in a neonate. Am J Dis Child 1981;135:418–419.PubMedGoogle Scholar
  38. 38.
    Washington RL, Barkin RM, Hillman JR. Septicemic plague that mimics Reye’ s syndrome. Am J Dis Child 1979;133:434.PubMedGoogle Scholar
  39. 39.
    Leopold JC. Septicemic plague in a 14-month old child. Pediatr Infect Dis 1986;5:108–110.PubMedCrossRefGoogle Scholar
  40. 40.
    Galimand M, Guiyoule A, Gerbaud G, et al. Multidrug resistance in Yersinia pestis mediated by a transferable plasmid. N Engl J Med 1997;337:677–680.PubMedCrossRefGoogle Scholar
  41. 41.
    Guiyoule A, Gerbaud G, Buchrieser C, et al. Transferable plasmid-mediated resistance to streptomycin in a clinical isolate of Yersinia pestis. Emerg Infect Dis 2001;7:43–48.PubMedCrossRefGoogle Scholar
  42. 42.
    Weber DJ, Rutalia WA. Risks and prevention of nosocomial transmission of rare zoonotic diseases. Clin Infect Dis 2001;32:446–456.PubMedCrossRefGoogle Scholar
  43. 43.
    Levison ME. Safety precautions to limit exposure from plague-infected patients [Letter]. JAMA 2000;284:1648.PubMedCrossRefGoogle Scholar
  44. 44.
    Inglesby TV, Henderson DA, O’Toole T, et al. Safety precautions to limit exposure from plague-infected patients [Letter]. JAMA 2000; 284:1648–1649.PubMedCrossRefGoogle Scholar
  45. 45.
    White ME, Gordon D, Polant JD, Barnes AM. Recommendations for the control of Yersinia pestis infections. Infect Control Hosp Epidemiol 1980;1:324–329.Google Scholar
  46. 46.
    Burmeister RW, Tigertt WD, Overholt EL. Laboratory-acquired pneumonic plague. Ann Intern Med 1962;56:789–800.PubMedGoogle Scholar
  47. 47.
    Centers for Disease Control and Prevention. Prevention of plague: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996CRR-14:7.Google Scholar
  48. 48.
    Cavanaugh DC, Elisburg BL, Llewellyn CH, et al. Plague immunization. V. Indirect evidence for the efficacy of the plague vaccine. J Infect Dis 1974;129(suppl):S37–540.CrossRefGoogle Scholar
  49. 49.
    Cohen RJ, Stockard JL. Pneumonic plague in an untreated plague-vaccinated individual. JAMA 1967;202:217–218.CrossRefGoogle Scholar
  50. 50.
    Cieslak TJ, Christopher GW, Kortepeter MG, et al. Immunization against potential biological warfare agents. Clin Infect Dis 2000;30:843–850.PubMedCrossRefGoogle Scholar
  51. 51.
    Reisman RE. Allergic reactions due to plague vaccine. J Allergy 1970;46:49–55.PubMedCrossRefGoogle Scholar
  52. 52.
    Titball RW, Williamson ED. Vaccination against bubonic and pneumonic plague. Vaccine 2001;19: 4175–4184.PubMedCrossRefGoogle Scholar
  53. 53.
    Jones SM, Day F, Stagg AJ, et al. Protection conferred by a fully recombinant sub-unit vaccine against Yersinia pestis in male and female mice of four inbred strains. Vaccine 2001;19:358–366.CrossRefGoogle Scholar
  54. 54.
    Eyles JE, Spiers ID, Williamson ED, et al. Analysis of local and systemic immunologic responses after intra-tracheal, intra-nasal and intra-muscular administration of microsphere co-encapsulated Yersinia pestis sub-unit vaccines. Vaccine 1998;16:2000–2009.PubMedCrossRefGoogle Scholar
  55. 55.
    Baca-Estrada ME, Foldvari M, Snider M, et al. Intranasal immunization with liposome-formulated Yersinia pestis vaccine enhances mucosal immune responses. Vaccine 2000;18:2203–2211.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2004

Authors and Affiliations

  • Jennifer C. Thompson

There are no affiliations available

Personalised recommendations