Arizona man spent a month not knowing he had the plague

A man in Arizona has spent nearly a month not knowing he had contracted the plague, which can be fatal if not treated quickly, according to a new report.

The man has recovered, but his case underscores the need to identify infections with serious and potentially contagious pathogens, such as Yersinia pestis – the bacteria that causes plague – in a timely manner, according to the report, from the Centers for Disease Control and Prevention (CDC).

The 67-year-old first went to the emergency room on June 18, 2020, with symptoms of dehydration, nausea and weakness, according to the case report, which was published Thursday August 5 in the journal CDC. Morbidity and Mortality. Weekly report. The doctors treated him with intravenous fluids and released him soon after. But he returned the next day with three painful red bumps on his leg that he thought were insect bites. This time, doctors suspected he was suffering from cellulitis, a skin infection caused by bacteria. He was prescribed for two antibiotics and again released from the hospital.

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The man returned the next day with more severe symptoms, including fever, dizziness, chills and “swollen glands”. He was admitted to hospital and treated with antibiotics for suspected sepsis, a life-threatening body inflammation that can result from infection.

He tested negative for COVID-19 twice and a blood sample was sent to a commercial lab to help identify the cause of his infection. On June 30, 2020, the lab reported that the man had tested positive for Yersinia pseudotuberculosis, a bacteria that can spread from animals to humans and cause fever, abdominal pain, and in some cases, a rash and infection of the blood. It is closely related to Yersinia pestis. The man began a two-week course of treatment with the antibiotic vancomycin and was released from hospital on July 1, 2020.

But the diagnosis of Y. pseudotuberculosis would be wrong. On July 10, 2020, the hospital sent a sample of the man’s blood to the Arizona State Public Health Laboratory, which identified Y. pestis in the sample. Health officials confirmed the diagnosis of plague on July 15, 2020, nearly a month after the man first felt the symptoms.

The man was diagnosed with septicaemic plague, a type of plague that causes fever, chills, extreme weakness, abdominal pain and sometimes bleeding in the skin and other organs, according to the CDC. (People with septicaemic plague have sepsis caused by Yersinia pestis.)

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He was then prescribed the appropriate treatment, in this case a 10-day course of the antibiotic doxycycline. The delay in diagnosis could have threatened the man’s chances of survival. “This patient did not receive high-efficacy antibiotic therapy… until about 30 days after the onset of symptoms,” the report states.

The man’s eventual recovery may be due, in part, to his early treatment with antibiotics; although they are not the best antibiotics for treating plague, they do have some effectiveness against plague bacteria, according to the report.

The plague is perhaps best known to have caused the Black Death in Europe in the 1300s. Infection still occurs today, but it is very rare, with about seven cases of plague occurring in the United States each year. , on average, according to the CDC. This man’s case was the first case of plague reported in Arizona since 2017, the authors said.

Humans can get plague from fleas or from contact with the tissues or bodily fluids of an infected animal. The man said he handled a dead rat (a rodent belonging to the genus Neotoma) while wearing gloves before falling ill.

Early and prompt treatment with antibiotics is important to avoid serious complications, including death. Before the advent of antibiotics, the plague death rate in the United States was around 66%, but today the rate is around 11%, according to the CDC.

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In Arizona, hospitals and laboratories that identify any bacteria of the Yersinia genus are required to submit samples to the state’s public health laboratory for further testing within one business day, according to the report. But in this case, there was a 10 day delay in submitting the sample. The reason for the delay is unclear, but lab staff have been re-educated on the requirement, according to the report.

“Prompt reporting could have led to a more rapid diagnosis of his acute disease and the initiation of more effective antibiotic therapy closer to the onset of the disease,” the report concludes.

Originally posted on Live Science.