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Plague  Lesson 2
 Clinical Presentation

Pneumonic Plague

Pneumonic plague is caused either by direct inhalation of infective respiratory droplets or aerosolized bacteria, or by secondary spread of infection to the lungs from another anatomic site.

Chest radiographs of untreated patients show rapidly expanding bronchopneumonic infiltrates. Pulmonary parenchymal necrosis and hemorrhage occur, and patients occasionally develop pulmonary abscesses and resultant cavities. Enlarged hilar nodes and pleural effusions may be present.

It has the following characteristics:

  • Incubation Period- 2-4 days with range of 1-6 days.
  • Symptoms
    • Acute onset of fever, chills, malaise, and myalgias associated with progressive lethargy.
    • A productive cough of copious watery mucoid sputum that may be bloody.
    • Associated chest pain and increasing dyspnea.
  • Progression of Disease- As the disease progresses, adult respiratory distress syndrome (ARDS) characterized by refractory pulmonary edema, may occur. Signs of shock, including hypotension and eventual multi-organ failure, may also occur. Without early detection and treatment in less than 24 hours, pneumonic plague is almost universally fatal.
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Pneumonic Plague
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Anteroposterior X-ray
Anteroposterior X-Ray

Bilaterally Progressive Plague
Bilaterally Progressive

Bilateral Pulmonary Infection
Bilateral Pulmonary Infection

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Page last reviewed February 12, 2007
Page last modified September 7, 2004

  • Content source: CDC Emergency Risk Communication Branch (ERCB), Division of Emergency Operations (DEO), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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