There may or may not be a periadenitis but there is thickening of the capsule and fibrous septa of the glands. At times an apparently healthy gland may show a necrotic centre, the contents of which, however, will be found to be sterile. One often notes in sections haemorrhagic infiltrations and oedema in the region of the peripheral lymph sinuses. A point of differentiation from ambulant plague buboes is the great increase in plasma cells in climatic bubo. It will be remembered that Cantlie suggested that climatic bubo was an attenuated plague but this idea has never been accepted. It has been suggested that malaria might cause climatic bubo.
Symptomatology
The period of incubation is a rather long one, Rost in a well-controlled case noting a period of at least five weeks. The onset is very gradual, so the first intimation of a swelling in the groins may be when a sense of heaviness is noted in that region after prolonged work. For this reason they have been called “fatigue” glands.
The glands of one side of the groin are usually involved although the swellings may affect both sides. The deep iliac glands also often show marked increase in size but the glands of the other parts of the body, as axillary or cervical, are practically never involved.
The swollen glands are only slightly tender and at first are discrete and not attached to skin or underlying tissues. Later on with the development of a periadenitis they may be firmly attached. In size they are usually as large as a hen’s egg but may become much larger.
The overlying skin is as a rule normal and one may at times palpate a soft center in an otherwise hard gland. Fever tends to come on as an irregular remittent type and I have seen cases showing temperature curves covering periods of two or three months which were not unlike those of Malta fever. With increase in size of the buboes there would be a two or three weeks’ rise to be followed, with the subsidence of the swelling, by lysis and later on to be renewed with reappearance of the bubo.
Climatic bubo runs a protracted course and does not respond at all well to treatment. The cases often develop a moderate secondary anaemia, which is most often noted in the relapse cases.
Diagnosis and Treatment
The history aids in differentiating gonorrhoeal, chancroidal and syphilitic buboes. There is not the hardness and marked absence of tenderness we get in syphilitic inguinal glands, and the reddened overlying skin of the other veneral buboes should differentiate.