Yersinia pestis infection physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Apart from the presence of buboes, which are tender lymph nodes in patients infected with bubonic plague, the physical examination findings are not specific to plague. Nonetheless, physical examination is crucial to evaluate for the presence of target organ damage or the progression and worsening of infection burden in these patients.

Physical Examination

Buboes, which are fixed tender lymphadenopathy in patients with bubonic plague, are characteristic findings on physical examination. Otherwise, patients with plague infection generally have non-specific physical examination findings. Nonetheless, physical examination is key in all cases of plague for the evaluation of the patient's clinical picture and monitoring for clinical response.

General Appearance

Patients infected with plague are generally toxic-looking.

Vital Signs

• Fever is invariably present in all patients
• Tachycardia
• Tachypnea
• Hypotension in septicemic plague

HEENT

• Pharyngeal erythema
• Tonsilar enlargement
• Meningismus in plague complicated by meningitis

Skin

• Papules, pustules, ulcers, or vesicles surrounded by local erythema at site of infection
• Fixed tender lymphadenopathy of 1-10 cm in diameter in bubonic plague that may be present anywhere: Axillary, cervical, postauricular, inguinal, epitrochlear, or popliteal. Lymph nodes may demonstrate fluctuance, suppuration, and may eventually drain.

Abdomen

• Intra-abdominal buboes may present with abdominal tenderness, guarding, or signs of peritoneal irritation, such as rebound tenderness and abdominal rigidity.
• Hepatomegaly

Extremities

• Black gangrenous distal upper and lower extremities
• Warm skin in septic patients
• Petechiae in patients with disseminated intravascular coagulopathy (DIC)