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Published Date: 2012-06-12 21:40:57
Subject: PRO/AH/EDR> Plague - USA (02): (OR), septicemic
Archive Number: 20120612.1165863

PLAGUE - USA (02): (OREGON), SEPTICEMIC
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Date: Mon 11 Jun 2012
Source: KTVZ [edited]
http://www.ktvz.com/news/31180725/detail.html

Crook County health officials said Mon, 11 Jun 2012, they are investigating a probable case of human plague involving a man in his 50s who is being treated at a local hospital. Contacts with the individual have been notified and are receiving preventive antibiotics, officials said. The man reported contact with a sick stray cat in his neighborhood, they added.

Crook County officials did not identify the man, citing patient confidentiality regulations, but a family member contacted NewsChannel 21, which then learned he's in critical condition at St. Charles Medical Center-Bend. A family member told us he's been only given 30 percent survival odds at present.

The man was bitten by the cat last week and within 48 hours was taken to a Portland hospital for treatment. He was then moved to Bend, where he is now fighting for his life. Friends say his organs started shutting as they wait to see if antibiotics can get rid of the illness.

Plague is spread to humans or animals through a bite from an infected flea or by contact with an animal sick with the disease. "People can protect themselves, their family members and their pets," said Karen Yeargain, communicable disease coordinator with the Crook County Health Department. "Using flea treatment on your pets will prevent your pets from bringing fleas into your home. Plague is serious but it is treatable with antibiotics if caught early."

A domestic cat in Crook County tested positive for bubonic plague a year ago. "For people, it's the cats bringing home the fleas to a household or being in contact with a cat or dog who is actually sick with the plague," Yeargain told NewsChannel 21. "Almost exactly a year ago, we did have a cat diagnosed with the plague," said Yeargain, "that cat also had septicemic, or bloodstream infection, and that cat did pull through."

Plague is rare in Oregon. Only 3 human cases have been diagnosed statewide since Crook County's last case of plague in 1995. According to Yeargain, the last Crook County case occurred in a resident who was exposed to plague-infected fleas from household cats that hunted rodents in the fields. 2 of 3 cats in that household also tested positive for plague exposure. In 2010, 2 human cases of plague were diagnosed in Lake County. Further investigation revealed that the family dog had also been exposed to plague. In 2011, an additional case with exposures in Lake County was diagnosed. There were no fatalities in humans or household animals in these cases.

Symptoms of plague typically develop within 1 to 4 days after exposure. 3 clinical syndromes have been described; bubonic (lymph node infection), septicemic (blood infection), and pneumonic (lung infection). Bubonic plague is the most common form and is characterized by high temperatures, lethargy and swollen lymph nodes, most commonly in the neck and under the jaw. Infected lymph nodes may spontaneously abscess and drain.

Collin Gillin, DVM, Oregon Department of Fish and Wildlife, reminds people that if anyone observes sick or dead rodents of any kind, to contact the Oregon Department of Fish and Wildlife veterinarians. Some additional steps to prevent flea bites are to wear insect repellant, tuck pant cuffs into socks when in areas heavily occupied by rodents, and avoid contact with wildlife including rodents. Pet owners are encouraged to keep cats indoors. Also, do not handle ill-appearing stray or wild animals.

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[Most cases of _Yersinia pestis_ infections in the USA are reported from the Four Corners area of the USA where the states of Colorado, Utah, Arizona and New Mexico come together although as mentioned in the posting, cases occur in Oregon as well as California.

As outlined by the CDC (Centers for Disease Control and Prevention) at http://www.cdc.gov/ncidod/dvbid/plague/diagnosis.htm: "Death from bubonic plague occurs after the bacterium _Yersinia pestis_ escapes from the infected bubo into the bloodstream (septicemic plague) causing the manifestations of the sepsis syndrome. Disseminated intravascular coagulation (DIC) with subsequent cutaneous hemorrhage may well have been what was called the 'Black Death' in the Middle Ages. The bacterium can spread to the lungs, causing a secondary plague pneumonia (secondary to the bacteremia), or to the meninges, causing a plague meningitis. Both of these events have a high case fatality rate and the secondary plague pneumonia is the way the infection spreads (by aerosol) from person to person.

"The typical sign of the most common form of human plague is a swollen and very tender lymph gland, accompanied by pain. The swollen gland is called a "bubo." Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2 to 6 days after being infected.

"When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. About 14 per cent (1 in 7) of all plague cases in the United States are fatal."

The severity of the illness in this man suggests that septicemic plague is occurring here. The need for chemoprophylaxis suggests a concern regarding pneumonic plague which can transmit from person-to-person.

[The interactive HealthMap/ProMED map for the state of Oregon is available at: http://healthmap.org/r/1fWb. - Mod.LL]

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