A patient with fever, chills, weakness, very swollen tender lymph nodes (bubo), and skin ulcerations at the sites of very small insect bites is most consistent with which type of plague?

• A. Bubonic
• B. Pneumonic
• C. Septicemic
• D. Typhus

Answer: (A)

Swollen, tender lymph nodes after a flea bite point to bubonic plague. The bacteria Yersinia pestis is transmitted by fleas and travels to regional lymph nodes, causing painful enlargement called buboes, often with a bite-site lesion. Pneumonic plague would present mainly with lung symptoms such as fever plus cough and shortness of breath, not prominent buboes. Septicemic plague involves widespread bloodstream infection and may lack noticeable regional lymphadenopathy. Typhus causes fever with a characteristic rash and does not feature the characteristic buboes tied to flea-transmitted plague. Therefore, this presentation aligns best with bubonic plague.