Table 10.

Diagnostic features of plague

Syndrome	Typical Time Course	Symptoms	Physical Findings	Laboratory Findingsa	Radiographic Findings
Bubonic	Incubation period 2–8 d 2 phases: 1. Early 1–2 d 2. Late 2–4 g	Early: Chills Malaise Headache Late: Headache Vomiting Chills Chest pain	Early: Fever Buboes (nodules) 1–10 cm in size, firm, nonfluctuant and tender Late: High fever Tachycardia Altered LOC Prostration Septic shock ARDS	Leukocytosis Increased bilirubin level Increased AST/ALT levels Findings of DIC	CXR: Bilateral pulmonary infiltrates with a nodular appearance Over time, the CXR looks the same as any patient with ARDS
Primary septicemic	Same as bubonic	Same as bubonic	Same as bubonic but no buboes Ischemia and necrosis of digits (black death)	Same as bubonic	Same as bubonic
Pneumonic	Short incubation period (24 h–3 d) followed by sudden onset of symptoms and rapid deterioration and death as early as 18–24 h after the onset of symptoms	Dyspnea Pleuritic chest pain Cough Malaise Myalgia/arthralgia Hemoptysis ± diarrhea ± agitation	High fever Respiratory failure Prostration Coma	Leukocytosis Lactic acidosis Hypoxemia on arterial blood gas	CXR: Multilobar air-space disease without significant hilar or mediastinal adenopathy

Abbreviations: ±, may have; AST/ALT, aminotransferase/alanine aminotransferase; CT, computed tomography scan; CXR, chest radiograph; DIC, disseminated intravascular coagulation; LOC, level of consciousness; MRI, magnetic resonance imaging.

^aFor microbiological findings, refer to Table 7.

Data from Refs.7, 18, 19, 52