Bubo aspiration

Fever, cough, and dyspnea bioody, watery sputum nausea, vomiting, abdominai pain, diarrhea DIAGNOSTIC SAMPLES blood, sputum, bubo aspirate cultures... 

Cultures of blood, bubo aspirate, sputum, and cerebrospinal fluid (if indicated) should be performed. Tiny, 1- to 3-mm beaten-copper colonies will appear on blood agar by 48 hours, but it is important to remember that cultures may be negative at 24 hours. In a recent study, 24 (96%) of 25 blood cultures of patients with bubonic plague were positive on standard supplemented peptone broth.59... 

If cervical buboes are present, aspiration performed with a 20-gauge needle and a 10-mL syringe containing 1-2 mL of sterile saline for infusing the node can provide a specimen suitable for culture and staining (23). 

Fig. 23-7. A femoral bubo (a), the most common site of an erythematous, tender, swollen, lymph node in patients with plague. This painful lesion may be aspirated in a sterile fashion to relieve pain and pressure it should not be incised and drained. The next most common lymph node regions involved are the inguinal, axillary (b), and cervical areas. Bubo location is a function of the region of the body in which an infected flea inoculates the plague bacilli. Photographs Courtesy of Ken Gage, Ph.D., Centers for Disease Control and Prevention, Fort Collins, Colo.

Fig. 23-8. Purpuric lesions can be seen on the upper chest of this girl with plague. The bandage on her neck indicates that a bubo has been aspirated. Photograph Courtesy Ken Gage, Ph.D., Centers of Disease Control and Prevention, Fort Collins, Colo.

Rarely, pharyngitis—resembling tonsillitis and associated with cervical lymphadenopathy—has been reported.17,55 A plague syndrome of cervical buboes, peritonsillar abscesses, and fulminant pneumonia has also been reported to occur among Indians of Ecuador, who are known to catch and kill fleas and lice with their teeth. It is thought, although not proven, that endobronchial aspiration from peritonsillar abscesses leads to fulminant pneumonia. A similar syndrome may have occurred in Vietnam.55... 

---