PLAGUE - USA: (OREGON), 2010, BUBONIC, CDC
*******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 24 Feb 2011
Source: Morbidity Mortality Weekly Report 2011;60:214 [edited]
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6007a4.htm?s_cid=mm6007a4_e&source=govdelivery>
Plague, caused by _Yersinia pestis_, is enzootic among rodents in the
western USA. Humans can be infected through 1) the bite of an infected
flea carried by a rodent or, rarely, other animals, 2) direct contact
with contaminated tissues, or 3) in rare cases, inhalation of
respiratory secretions from infected persons or animals. In September
2010, the Oregon Health Authority reported the 1st 2 cases of human
plague in Oregon since 1995 and the only 2 USA cases in 2010.
Both illnesses began on 21 Aug 2010. The patients, aged 17 and 42
years, lived in the same household and might have been exposed to
plague by infected fleas from a dog; that dog was found to be
seropositive for _Y. pestis_ by the passive
hemagglutination-inhibition assay (dilution of 1:64). One patient
acknowledged sleeping in the same bed with the dog during the 2 weeks
before illness onset. Both patients had high fever and multiple
bilateral inguinal buboes; one patient had hypotension, tachycardia,
and acute renal failure and was hospitalized. A gram-negative rod with
bipolar staining was isolated from a specimen of that patient's
blood.
Four different clinical laboratories attempted to identify the
isolate. Three different commercial automated systems identified the
organism as _Acinetobacter lwoffii_, _Pseudomonas luteola_, and
_Yersinia pseudotuberculosis_, respectively. However, 25 days after
specimen collection, the isolate was identified as _Y. pestis_ by
direct fluorescent antibody to F1 antigen, polymerase chain reaction,
and bacteriophage lysis at the Spokane (Washington) Regional Health
District Laboratory, prompting notification of the Oregon Health
Authority. The 2nd patient was identified retrospectively on the basis
of a single positive serology (passive hemagglutination-inhibition
[dilution of 1:32]). Plague was not suspected initially. Both patients
recovered uneventfully after empiric therapy with doxycycline and
amoxicillin clavulanate potassium, respectively, although the latter
is not considered effective in treating plague.
Automated bacterial identification systems can misidentify _Y.
pestis_ (1,2). Automated identification of _Yersinia_ spp. in blood
should prompt further clinical evaluation of the patient to determine
whether symptoms are compatible with plague. When plague is suspected,
treatment should be started immediately, and both the state public
health laboratory and public health authorities should be notified
promptly.
Plague is a Category A potential bioterrorism agent. Human infections
are rare but can be life-threatening. The plague case-fatality rate
depends on the clinical presentation (i.e., bubonic, septicemic, or
pneumonic) and timing of antibiotic therapy initiation; if untreated,
the case-fatality rate is over 50 percent for bubonic plague and
approaches 100 percent for pneumonic plague (3). Rapid laboratory
identification can help guide therapy.
Sleeping in the same bed with dogs has been associated with plague in
enzootic areas (4). Plague patients with no history of exposure to
rodents can be infected by _Y. pestis_ if their pets carry infected
rodent fleas into the home. Veterinarians always should recommend flea
control to dog and cat owners.
References
--------
1. American Society for Microbiology: Sentinel laboratory guidelines
for suspected agent of bioterrorism: Yersinia pestis. Washington, DC:
American Society for Microbiology; 2009. Available at
<http://www.asm.org/images/pdf/Clinical/ypestis12-11-09.pdf>. Accessed
17 Feb 2011.
2. CDC: Fatal human plague---Arizona and Colorado, 1996. MMWR
1997;46:617-620.
3. CDC: Human plague---four states, 2006. MMWR 2006;55:940-943.
4. Gould LH, Pape J, Ettestad P, Griffith KS, Mead PS: Dog-associated
risk factors for human plague. Zoonoses Public Health
2008;55:448-454.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[This CDC report adds additional information regarding the 2 cases of
bubonic plague in Oregon that occurred in August 2010. Most cases of
_Y. pestis_ infections in the USA occur in the area of the "Four
Corner" states: Colorado, Arizona, New Mexico and Utah. - Mod.LL]
[see also:
Plague, fatal - USA: (IL), 2009, lab strain, CDC 20110224.0614
2010
----
Plague - USA (03): (OR) bubonic 20101004.3597
Plague - USA (02): (CA) rodent 20100819.2878
Plague, wildlife - Canada: (SK) prairie dog 20100817.2849
Plague, feline - USA: (MT) 20100807.2693
Plague - USA: (CA) ground squirrel 20100708.2275
Plague, canine - USA: (NM) 20100418.1259
Plague, cougar - USA (WY) 20100208.0429
2009
----
Plague, feline - USA (CA) 20091205.4150
Plague, fatal - USA (05): (IL) lab strain susp. RFI 20090921.3320
Plague, fatal - USA (03): (NM) recovery 20090715.2530
Plague, tularemia, prairie dogs - USA (SD) 20090712.2494
Plague, fatal - USA (02): (NM) risk, prevention 20090611.2153
Plague, fatal - USA: (NM) bubonic 20090605.2080
Plague, rabbit - USA (NM) 20090415.1435
2008
----
Plague, human, prairie dogs - USA: (AZ) 20081012.3229
Plague, prairie dogs, ferrets - USA: (SD) (02) 20080722.2213
Plague, prairie dog, ferrets - USA: (SD) 20080708.2082
Plague, prairie dogs - USA: (CO), susp., RFI 20080506.1552
Plague, human, feline - USA (NM): early season cases 20080127.0340]
..................................................ll/msp/dk
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
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<http://www.isid.org/ProMEDMail_Donations.shtml>
************************************************************
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For assistance from a human being, send mail to:
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*******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 24 Feb 2011
Source: Morbidity Mortality Weekly Report 2011;60:214 [edited]
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6007a4.htm?s_cid=mm6007a4_e&source=govdelivery>
Plague, caused by _Yersinia pestis_, is enzootic among rodents in the
western USA. Humans can be infected through 1) the bite of an infected
flea carried by a rodent or, rarely, other animals, 2) direct contact
with contaminated tissues, or 3) in rare cases, inhalation of
respiratory secretions from infected persons or animals. In September
2010, the Oregon Health Authority reported the 1st 2 cases of human
plague in Oregon since 1995 and the only 2 USA cases in 2010.
Both illnesses began on 21 Aug 2010. The patients, aged 17 and 42
years, lived in the same household and might have been exposed to
plague by infected fleas from a dog; that dog was found to be
seropositive for _Y. pestis_ by the passive
hemagglutination-inhibition assay (dilution of 1:64). One patient
acknowledged sleeping in the same bed with the dog during the 2 weeks
before illness onset. Both patients had high fever and multiple
bilateral inguinal buboes; one patient had hypotension, tachycardia,
and acute renal failure and was hospitalized. A gram-negative rod with
bipolar staining was isolated from a specimen of that patient's
blood.
Four different clinical laboratories attempted to identify the
isolate. Three different commercial automated systems identified the
organism as _Acinetobacter lwoffii_, _Pseudomonas luteola_, and
_Yersinia pseudotuberculosis_, respectively. However, 25 days after
specimen collection, the isolate was identified as _Y. pestis_ by
direct fluorescent antibody to F1 antigen, polymerase chain reaction,
and bacteriophage lysis at the Spokane (Washington) Regional Health
District Laboratory, prompting notification of the Oregon Health
Authority. The 2nd patient was identified retrospectively on the basis
of a single positive serology (passive hemagglutination-inhibition
[dilution of 1:32]). Plague was not suspected initially. Both patients
recovered uneventfully after empiric therapy with doxycycline and
amoxicillin clavulanate potassium, respectively, although the latter
is not considered effective in treating plague.
Automated bacterial identification systems can misidentify _Y.
pestis_ (1,2). Automated identification of _Yersinia_ spp. in blood
should prompt further clinical evaluation of the patient to determine
whether symptoms are compatible with plague. When plague is suspected,
treatment should be started immediately, and both the state public
health laboratory and public health authorities should be notified
promptly.
Plague is a Category A potential bioterrorism agent. Human infections
are rare but can be life-threatening. The plague case-fatality rate
depends on the clinical presentation (i.e., bubonic, septicemic, or
pneumonic) and timing of antibiotic therapy initiation; if untreated,
the case-fatality rate is over 50 percent for bubonic plague and
approaches 100 percent for pneumonic plague (3). Rapid laboratory
identification can help guide therapy.
Sleeping in the same bed with dogs has been associated with plague in
enzootic areas (4). Plague patients with no history of exposure to
rodents can be infected by _Y. pestis_ if their pets carry infected
rodent fleas into the home. Veterinarians always should recommend flea
control to dog and cat owners.
References
--------
1. American Society for Microbiology: Sentinel laboratory guidelines
for suspected agent of bioterrorism: Yersinia pestis. Washington, DC:
American Society for Microbiology; 2009. Available at
<http://www.asm.org/images/pdf/Clinical/ypestis12-11-09.pdf>. Accessed
17 Feb 2011.
2. CDC: Fatal human plague---Arizona and Colorado, 1996. MMWR
1997;46:617-620.
3. CDC: Human plague---four states, 2006. MMWR 2006;55:940-943.
4. Gould LH, Pape J, Ettestad P, Griffith KS, Mead PS: Dog-associated
risk factors for human plague. Zoonoses Public Health
2008;55:448-454.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[This CDC report adds additional information regarding the 2 cases of
bubonic plague in Oregon that occurred in August 2010. Most cases of
_Y. pestis_ infections in the USA occur in the area of the "Four
Corner" states: Colorado, Arizona, New Mexico and Utah. - Mod.LL]
[see also:
Plague, fatal - USA: (IL), 2009, lab strain, CDC 20110224.0614
2010
----
Plague - USA (03): (OR) bubonic 20101004.3597
Plague - USA (02): (CA) rodent 20100819.2878
Plague, wildlife - Canada: (SK) prairie dog 20100817.2849
Plague, feline - USA: (MT) 20100807.2693
Plague - USA: (CA) ground squirrel 20100708.2275
Plague, canine - USA: (NM) 20100418.1259
Plague, cougar - USA (WY) 20100208.0429
2009
----
Plague, feline - USA (CA) 20091205.4150
Plague, fatal - USA (05): (IL) lab strain susp. RFI 20090921.3320
Plague, fatal - USA (03): (NM) recovery 20090715.2530
Plague, tularemia, prairie dogs - USA (SD) 20090712.2494
Plague, fatal - USA (02): (NM) risk, prevention 20090611.2153
Plague, fatal - USA: (NM) bubonic 20090605.2080
Plague, rabbit - USA (NM) 20090415.1435
2008
----
Plague, human, prairie dogs - USA: (AZ) 20081012.3229
Plague, prairie dogs, ferrets - USA: (SD) (02) 20080722.2213
Plague, prairie dog, ferrets - USA: (SD) 20080708.2082
Plague, prairie dogs - USA: (CO), susp., RFI 20080506.1552
Plague, human, feline - USA (NM): early season cases 20080127.0340]
..................................................ll/msp/dk
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/ProMEDMail_Donations.shtml>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://www.isid.org/promedmail/subscribe.lasso>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.