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Plague

  • Jennifer C. Thompson
Chapter

Abstract

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).

Keywords

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.

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© Humana Press Inc., Totowa, NJ 2004

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  • Jennifer C. Thompson

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