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Bubonic Plague: Detection of Endotoxemia with the Limulus Test

[+] Article, Author, and Disclosure Information

Grant support: Bureau of Medicine and Surgery, Navy Department, Work Unit MRO41.20.01-0362A 2GI; NIH Training Grant No. AI-00009; and Research Grant HL-01601 from the National Heart and Lung Institute of the National Institutes of Health.

▸Requests for reprints should be addressed to Thomas Butler, M.D., Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD 21205.

Baltimore, Maryland, and Danang, Republic of Vietnam

Ann Intern Med. 1973;79(5):642-646. doi:10.7326/0003-4819-79-5-642
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Nine of 10 patients with fever and bubo were confirmed as having bubonic plague by isolation of Yersinia pestis from bubo aspirates or blood, or by serological responses. Common features were prostration, tachycardia, leukocytosis, thrombocytopenia, prolonged partial thromboplastin times, and abnormal liver function tests. Three patients were hypotensive, and one died. The limulus test detected endotoxemia in all nine confirmed cases at the time of admission. The limulus test was negative during convalescence in five of eight patients; three persistently positive cases had symptoms or laboratory findings suggesting continued effects of infection. Lyophilized bacteria from cultures of Y. pestis contained concentrations of endotoxin, as defined by the limulus test, similar to that in an equivalent mass of Escherichia coli. These data indicate further similarities between plague and other Gram-negative bacteremic infections and suggest that endotoxin may play a role in the acute symptoms of patients with plague.





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