Occurrence is thought to be underreported. Practitioners must maintain a high index of suspicion for plague, especially with patients exposed to animals or fleas in endemic areas. The most common complications are secondary septicemia, pneumonia, and meningitis. Polyarthritis, lung abscesses, and superinfection of lymph nodes also occur. This high mortality rate reflects the difficulty in diagnosis, given the disease s similarity to gram-negative bacterial sepsis.
Diagnosis often is made postmortem.
Since then, cases of primary pneumonic plague have been acquired chiefly from infected cats. A nearly equal sex distribution has been noted in more recent reviews. Both of the deaths reported in the United States in 1996 occurred in adolescents. Sore throat may be the only complaint of patients with plague pharyngitis. Bubonic plague Patients complain of fever with abrupt onset and other constitutional symptoms.