The rodents are divided into five subgroups; those who have not contracted the disease but may get it if they get in contact with [I.sub.HS], [I.sub.HP], [I.sub.RS], [I.sub.HP], [I.sub.F], or A, referred to as susceptible rodents and denoted by [S.sub.R]; those who have the disease but have not shown any symptom and are incapable of transmitting the disease referred to as exposed and denoted by [E.sub.R]; those who are infected and capable of transmitting the disease are divided into three subgroups: those who have bubonic plague denoted by [I.sub.RB], those with
septicemic plague denoted by [I.sub.RS], and those who have pneumonic plague [I.sub.RP].
In Johannesburg in 1904, a total of 48 cases of bubonic, mixed, and
septicemic plague were reported.
Pathology findings for the case described in this report are consistent with
septicemic plague and inconsistent with pneumonic plague, suggesting a transdermal or mucosal route of infection.
Patients with
septicemic plague often have prominent gastrointestinal symptoms, including nausea, vomiting, diarrhea, and abdominal pain (4), and patients with pneumonic plague have dyspnea, chest pain, and a cough that can produce bloody sputum.
* Infection can progress to shock (
septicemic plague) and pneumonia (pneumonic plague).
Among case-patients who had a known flea bite, 95 cases (90%) were primary bubonic plague and 10 (9%) were primary
septicemic plague. Of the 89 case-patients who had flea-acquired bubonic plague and bubo information, 59 (66%) displayed either inguinal or femoral adenopathy.
In 1996, five cases of human plague, of which two were fatal, were reported in the United States; both decedents had
septicemic plague that was not diagnosed until after they died.
Toward the end of the fourteenth century, the epidemic had abated but not disappeared; outbreaks of pneumonic and
septicemic plague occurred in different cities during the next 350 years (8).
In particular, bubonic plague is characterized by painful swelling of lymph nodes (buboes) in the inguinal, axillary, or cervical regions; pneumonic plague is characterized by cough and dyspnea; and
septicemic plague may result in fulminant gram-negative shock without localized signs of infection (2,6).
Bites, scratches, or other contact with infectious material while handling infected cats resulted in 17 cases of bubonic plague, 1 case of primary
septicemic plague, and 5 cases of primary pneumonic plague (5).
Because of the possibility of
septicemic plague (sepsis due to Yersinia pestis ), an aliquot of serum obtained on admission was tested on June 8 at New Mexico Health Department's Scientific Laboratory Division (SLD); the hemagglutination antiplague titer was 2048 (normal: <16).