Published Date: 2012-07-19 11:39:18
Subject: PRO/AH/EDR> Plague - USA (03): (OR) septicemic, recovery
Archive Number: 20120719.1206257
PLAGUE - USA (03): (OREGON), SEPTICEMIC, RECOVERY
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A ProMED-mail post
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International Society for Infectious Diseases
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Tue 18 Jul 2012
Source: The Guardian [edited]
http://www.guardian.co.uk/world/2012/jul/18/oregon-man-case-plague
An Oregon man who contracted a rare case of the plague trying to take a mouse from the jaws of a choking cat is no longer in a critical condition and has talked about his fears of losing all of his fingers as a result of the disease.
The family of the man, a welder from Prineville in rural Oregon, released pictures showing his hands withered by the cell-killing infection and darkened to the color of charcoal.
"I don't think I can do my job," he told the Associated Press in a phone interview from hospital. I'm going to lose all my fingers on both hands. I don't know about my thumbs. The toes, I might lose all them, too."
"We didn't even know the plague was around anymore," said his sister. "We thought that was an ancient, ancient disease."
The disease, which rampaged through Europe in the Middle Ages and is thought to have wiped out between 1/4th and 1/3rd of the population, is caused by the _Yersinia pestis_ bacterium. It can develop into 3 kinds of plague, including bubonic plague, which swells lymph nodes across the body. The other 2 are septicemic plague, which affects the bloodstream, and pneumonic plague, which affects the lungs.
The illness began after he saw a stray cat with a dead mouse jammed in the back of his throat. The cat appeared to be choking, so he and a friend attempted to dislodge the mouse. The distressed cat bit his hand. Unable to remove the mouse, the man shot the cat to end his suffering and buried him in the yard. Two days later, he awoke with a fever and chills.
He spent nearly a month on life support and only recently left the intensive care unit. At one point, doctors thought he was going to die, said his wife.
The cat's body was dug up, and tests confirmed it had the plague. Other cats and dogs in the area were tested, and none had the disease.
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[Septicemic plague can cause peripheral gangrene. A photograph of the patient's hand can be found at:
http://www.komonews.com/news/local/Oregon-man-recovering-from-rare-case-of-plague-162820406.html?tab=gallery&c=y&img=0.
Not necessarily relevant for this posting, in an in-press report (Turdjman M, Ibraheem M, Brett M, et al: Misidentification of _Yersinia pestis_ by automated systems, resulting in delayed diagnoses of human plague infections - Oregon and New Mexico. Clin Infect Dis 2012, in press), the authors underscore the importance of clinical diagnosis of plague because automated systems can misidentify it. In theses cases, the Oregon case was initially identified as _Acinetobacter lwoffii_ by one lab, _Pseudomonas luteola_ by a 2nd and _Yersinia pseudotuberculosis_ by a 3rd. In the 2nd case, the lab 1st identified the isolate as _P. luteola_. Misidentification can delay appropriate treatment as well as isolation if needed for pneumonic plague.
Of note, the same publication reports on unpublished data from CDC regarding the number of confirmed cases of human plague in the USA. From 1990 to 2010, 142 confirmed cases occurred, predominantly in Arizona, California, Colorado and New Mexico. Of the 139 cases with clinical data available, 75 percent were bubonic (with a 7 percent mortality); 21 percent were septicemic (with a 24 percent mortality), and 4 percent were pneumonic (with a 50 percent mortality). - Mod.LL
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1fWb.]
See Also
Plague - USA (02): (OR), septicemic 20120612.1165863Plague - USA: (NM) 20120601.1153277
2011
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Plague - USA (05): (OR), septicemic 20110920.2855
Plague, animal - USA (04): (NM) canine 20110701.1999
Plague, animal - USA (03): (CO) 20110612.1792
Plague, animal - USA (02): (OR) feline 20110610.1773
Plague - USA (03): (NM) bubonic 20110530.1655
Plague - USA (02): (NM) bubonic 20110510.1439
Plague, animal - USA: (NM) canine, feline 20110421.1240
Plague - USA: (OR), 2010, bubonic, CDC 20110224.0615
Plague, fatal - USA: (IL), 2009, lab strain, CDC 20110224.061
Plague - USA: (OR), 2010, bubonic, CDC 20110224.0615
Plague, fatal - USA: (IL), 2009, lab strain, CDC 20110224.0614
2010
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Plague - USA (03): (OR) bubonic 20101004.3597
Plague - USA (02): (CA) rodent 20100819.2878
Plague, feline - USA: (MT) 20100807.2693
Plague - USA: (CA) ground squirrel 20100708.2275
Plague, canine - USA: (NM) 20100418.1259
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