An illness characterized by fever, chills, headache, malaise, prostration, and leukocytosis, plague manifests predominantly in one of the following clinical forms: (1) bubonic plague, manifested by regional lymphadenitis, (2) septicemic plague, in which there is septicemia without evident bubo, (3) pneumonic plague, where pneumonia results from either inhalation of infectious droplets (primary pneumonic plague) or hematologic spread from bubonic or septicemic cases (secondary pneumonic plague), or (4) pharyngeal plague, in which there is pharyngitis and cervical lymphadenitis resulting from exposure to larger infectious droplets or ingestion of infected tissues.
Presumptive laboratory diagnosis is made by (1) an increase in serum antibody titers to Yersinia pestis fraction 1 antigen without plague vaccination or (2) detection of fraction 1 antigen by fluorescent assay. Confirmatory laboratory diagnosis is produced by (1) isolation of Y. pestis in clinical specimens or (2) a fourfold or greater rise in serum antibody titer to Y. pestis fraction 1 antigen.
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