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.36 In those that do progress to secondary septicemia, as well as those presentingsepticemic but without lymphadenopathy (primary septicemia), the symptoms aresimilar to other Gram-negative septicemias: high fever, chills, malaise, hypotension,nausea, vomiting, and diarrhea.However, plague septicemia can also producethromboses in the acral vessels, with necrosis and gangrene, and DIC.Black necroticappendages and more proximal purpuric lesions caused by endotoxemia are oftenpresent.Organisms can spread to the central nervous system, lungs, and elsewhere.Plague meningitis occurs in about 6% of septicemic and pneumonic cases.Pneumonic plague is an infection of the lungs due to either inhalation of theorganisms (primary pneumonic plague), or spread to the lungs from septicemia(secondary pneumonic plague).After an incubation period varying from 1 to 6 days forprimary pneumonic plague (usually 2-4 days, and presumably dose-dependent), onsetis acute and often fulminant.The first signs of illness include high fever, chills,headache, malaise, and myalgias, followed within 24 hours by a cough with bloodysputum.Although bloody sputum is characteristic, it can sometimes be watery or, lesscommonly, purulent.Gastrointestinal symptoms, including nausea, vomiting, diarrhea,and abdominal pain, may be present.Rarely, a cervical bubo might result from aninhalational exposure.The chest X-ray findings are variable, but most commonly revealbilateral infiltrates, which may be patchy or consolidated.The pneumonia progressesrapidly, resulting in dyspnea, stridor, and cyanosis.The disease terminates withrespiratory failure, and circulatory collapse.Nonspecific laboratory findings include a leukocytosis, with a total WBC countup to 20,000 cells with increased bands, and greater than 80 percentpolymorphonuclear cells.One also often finds increased fibrin split products in theblood indicative of a low-grade DIC.The BUN, creatinine, ALT, AST, and bilirubin mayalso be elevated, consistent with multiorgan failure.In man, the mortality of untreated bubonic plague is approximately 60 percent(reduced to [ Pobierz całość w formacie PDF ]
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.36 In those that do progress to secondary septicemia, as well as those presentingsepticemic but without lymphadenopathy (primary septicemia), the symptoms aresimilar to other Gram-negative septicemias: high fever, chills, malaise, hypotension,nausea, vomiting, and diarrhea.However, plague septicemia can also producethromboses in the acral vessels, with necrosis and gangrene, and DIC.Black necroticappendages and more proximal purpuric lesions caused by endotoxemia are oftenpresent.Organisms can spread to the central nervous system, lungs, and elsewhere.Plague meningitis occurs in about 6% of septicemic and pneumonic cases.Pneumonic plague is an infection of the lungs due to either inhalation of theorganisms (primary pneumonic plague), or spread to the lungs from septicemia(secondary pneumonic plague).After an incubation period varying from 1 to 6 days forprimary pneumonic plague (usually 2-4 days, and presumably dose-dependent), onsetis acute and often fulminant.The first signs of illness include high fever, chills,headache, malaise, and myalgias, followed within 24 hours by a cough with bloodysputum.Although bloody sputum is characteristic, it can sometimes be watery or, lesscommonly, purulent.Gastrointestinal symptoms, including nausea, vomiting, diarrhea,and abdominal pain, may be present.Rarely, a cervical bubo might result from aninhalational exposure.The chest X-ray findings are variable, but most commonly revealbilateral infiltrates, which may be patchy or consolidated.The pneumonia progressesrapidly, resulting in dyspnea, stridor, and cyanosis.The disease terminates withrespiratory failure, and circulatory collapse.Nonspecific laboratory findings include a leukocytosis, with a total WBC countup to 20,000 cells with increased bands, and greater than 80 percentpolymorphonuclear cells.One also often finds increased fibrin split products in theblood indicative of a low-grade DIC.The BUN, creatinine, ALT, AST, and bilirubin mayalso be elevated, consistent with multiorgan failure.In man, the mortality of untreated bubonic plague is approximately 60 percent(reduced to [ Pobierz całość w formacie PDF ]