Septicemic Plague in New Mexico

cemic. We reviewed these cases to better describe the clinical presentation of this disorder and to identify risk factors for developing septicemic plague. The symptoms (fever, chills, malaise, headache, and gastrointestinal symptoms) and signs (tachycardia, tachypnea, and hypotension) of septicemic plague are similar to those of other forms of gram-negative septicemia. Abdominal pain was reported in nearly half of the cases, and differential white blood cell counts revealed a marked shift to the left. The risk of developing septicemic plague was higher for persons >40 years of age. Because of empirical antibiotic treatment of older persons, deaths from septicemic plague occurred primarily among persons <30 years old. Deaths from septicemic plague could be reduced by aggressive antibiotic therapy for patients with a clinical presentation suggesting gram-negative septicemia, especially patients <30 years old. The majority of patients with plague present to the physician with bubonic plague, a febrile lymphadenitis. A smaller percentage of plague-infected individuals, however, present with the septicemic form of the disease, in which the blood culture is positive for Yersinia pestis but no bubo is found by physical examination. New Mexico has recently had an unusually large number of cases of septicemic plague. The deaths of several patients and the survival of others because of a fortuitous choice of antibiotics has prompted us to review the records of plague cases occurring in New Mexico during the last five years. We undertook this study to better describe the clinical presentation of this disorder and to identify risk