A patient presents with fever, cough, dyspnea, prominent gastrointestinal symptoms, and absence of buboes. Which form of plague is responsible?

A patient presents with fever, cough, dyspnea, prominent gastrointestinal symptoms, and absence of buboes. Which form of plague is responsible?

• A. Bubonic plague
• B. Septicemic plague
• C. Pneumonic plague
• D. Cutaneous plague

Answer: (C)

Recognizing plague forms by how the infection presents helps distinguish the type. The absence of buboes argues against the bubonic form, which classically causes swollen regional lymph nodes. The presence of cough and dyspnea points to lung involvement, i.e., pneumonia. When plague presents with pneumonia—fever plus respiratory symptoms—the form is pneumonic plague, which can be primary (from inhaling infectious droplets) or secondary to another form. While gastrointestinal symptoms can occur with plague, septicemic plague typically presents with systemic signs like shock and abdominal symptoms without prominent respiratory illness. The combination of fever, cough, and shortness of breath with no buboes most strongly fits pneumonic plague, which is also the form with the highest transmission risk and urgent public health implications.

Recognizing plague forms by how the infection presents helps distinguish the type. The absence of buboes argues against the bubonic form, which classically causes swollen regional lymph nodes. The presence of cough and dyspnea points to lung involvement, i.e., pneumonia. When plague presents with pneumonia—fever plus respiratory symptoms—the form is pneumonic plague, which can be primary (from inhaling infectious droplets) or secondary to another form. While gastrointestinal symptoms can occur with plague, septicemic plague typically presents with systemic signs like shock and abdominal symptoms without prominent respiratory illness. The combination of fever, cough, and shortness of breath with no buboes most strongly fits pneumonic plague, which is also the form with the highest transmission risk and urgent public health implications.