Fleck-Derderian Shannon, Cooley Katharine M, Nelson Christina A
Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado.
Vector Borne Zoonotic Dis. 2022 Apr;22(4):225-231. doi: 10.1089/vbz.2022.0012. Epub 2022 Apr 11.
Bubonic plague classically manifests as a painful, swollen superficial lymph node (bubo) that is readily apparent on physical examination. However, patients occasionally present with buboes formed in deep lymph nodes, which are difficult to detect and can lead to delays in diagnosis and treatment. To better characterize this phenomenon, we conducted a review of the published literature to identify reports of occult buboes among patients with plague. Articles were identified from two sources: a systematic review on plague treatment, and a search of the PubMed Central database. Articles were eligible if they described a patient with plague who had (1) no evidence of lymphadenopathy on examination; and (2) at least one bubo discovered during surgery or autopsy. Six patients with occult buboes were identified among 5120 articles screened. The majority were male ( = 4/6) and three were <15 years of age. Fever ( = 6/6), leukocytosis ( = 5/6), and abdominal pain or distention ( = 4/6) were the most common signs and symptoms. Initial diagnoses included other bacterial infections, appendicitis, or acute abdomen. Four patients received at least one antimicrobial effective against ; however, some experienced delayed treatment due to late diagnosis of plague. Occult buboes were discovered in retroperitoneal ( = 2), inguinal/femoral ( = 2), mesenteric ( = 2), axillary ( = 1), and mediastinal ( = 1) regions. Four of the six patients died. Patients with occult buboes experienced delays in the diagnosis of plague and a high fatality rate. Clinicians in plague-endemic areas should consider the presence of occult buboes among patients with compatible symptoms and exposure history.
腺鼠疫的典型表现是在体格检查时易于发现的疼痛、肿大的浅表淋巴结（腹股沟淋巴结炎）。然而，患者偶尔会出现深部淋巴结形成的腹股沟淋巴结炎，这些淋巴结难以检测到，可能导致诊断和治疗延迟。为了更好地描述这一现象，我们对已发表的文献进行了综述，以确定鼠疫患者中隐匿性腹股沟淋巴结炎的报告。文章从两个来源确定：一项关于鼠疫治疗的系统综述，以及对PubMed Central数据库的搜索。如果文章描述的鼠疫患者具备以下条件，则符合入选标准：（1）检查时无淋巴结病证据；（2）手术或尸检期间发现至少一个腹股沟淋巴结炎。在筛选的5120篇文章中，确定了6例隐匿性腹股沟淋巴结炎患者。大多数为男性（4/6），3例年龄小于15岁。发热（6/6）、白细胞增多（5/6）以及腹痛或腹胀（4/6）是最常见的体征和症状。初始诊断包括其他细菌感染、阑尾炎或急腹症。4例患者接受了至少一种有效的抗菌药物治疗；然而，一些患者由于鼠疫诊断延迟而经历了治疗延误。隐匿性腹股沟淋巴结炎在腹膜后（2例）、腹股沟/股部（2例）、肠系膜（2例）、腋窝（1例）和纵隔（1例）区域被发现。6例患者中有4例死亡。隐匿性腹股沟淋巴结炎患者经历了鼠疫诊断延迟和高死亡率。鼠疫流行地区的临床医生应考虑在有相关症状和暴露史的患者中存在隐匿性腹股沟淋巴结炎的可能性。
