Plague in a neonate.

More than half of the cases of plague in the United States are diagnosed in children. In the 1970s, 105 cases were reported, a 350% increase over the 1960s. Plague should be considered in the differential diagnosis of children from the western United States who have sepsis, especially those with lymphadenopathy. Complications of plague include meningitis, metabolic encephalopathy, abscess, and pneumonia. With appropriate treatment, prompt clinical response usually occurs. Careful isolation and epidemiologic investigation are essential to prevent the spread of the disease.