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Pathogenesis of plague

A review of plague deaths in the United States during the last decade
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      Abstract

      This is a review of the eight deaths from plague in the United States during the last decade. Three cases not previously reported are described and tissue specimens in four of the remaining five were available for examination. In four cases, all in children, fibrin thrombi were present in glomerular capillaries and elsewhere. This finding is the major pathologic manifestation of disseminated intravascular coagulation, which may be responsible for the hemorrhagic phenomena in plague because of the consumption of clotting factors. The similarity of the lesions to those of the generalized Shwartzman phenomenon suggests that lipopolysaccharide endotoxins of Pasteurella pestis may be responsible for the toxicity of this infection, and especially for the deaths in the patients whose tissues had been successfully sterilized by antibiotics.
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