{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T08:19:09Z","timestamp":1790410749988,"version":"4.1.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vector-Borne and Zoonotic Diseases"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Six patients with occult buboes were identified among 5120 articles screened. The majority were male (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20094\/6) and three were &lt;15 years of age. Fever (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20096\/6), leukocytosis (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20095\/6), and abdominal pain or distention (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20094\/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\n                      <jats:italic toggle=\"yes\">Yersinia pestis<\/jats:italic>\n                      ; however, some experienced delayed treatment due to late diagnosis of plague. Occult buboes were discovered in retroperitoneal (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20092), inguinal\/femoral (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20092), mesenteric (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20092), axillary (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20091), and mediastinal (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20091) regions. Four of the six patients died.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/vbz.2022.0012","type":"journal-article","created":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T11:26:22Z","timestamp":1649676382000},"page":"225-231","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Plague in Disguise: The Discovery of Occult Buboes on Surgical Procedure or Autopsy"],"prefix":"10.1177","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5607-6819","authenticated-orcid":false,"given":"Shannon","family":"Fleck-Derderian","sequence":"first","affiliation":[{"name":"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."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine M.","family":"Cooley","sequence":"additional","affiliation":[{"name":"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."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina A.","family":"Nelson","sequence":"additional","affiliation":[{"name":"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."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,4,19]]},"reference":[{"key":"e_1_3_4_2_1","first-page":"554","article-title":"Plague meningitis\u2014A retrospective analysis of cases reported in the United States, 1970\u20131979","volume":"147","author":"Becker TM","year":"1987","unstructured":"Becker TM, , Poland JD, , Quan TJ, , White ME, et al. 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