Shiloh
Editor, Senior Moderator
Source: https://www.cdc.gov/mmwr/volumes/70/wr/mm7031a1.htm?s_cid=mm7031a1_w
Notes from the Field: Delays in Identification and Treatment of a Case of Septicemic Plague — Navajo County, Arizona, 2020
Weekly / August 6, 2021 / 70(31);1063–1064
Ariella P. Dale, PhD; Melissa Kretschmer, MA; Irene Ruberto, PhD; David M. Wagner, PhD, Cathy Solomon; Kenneth Komatsu, MPH; Heather Venkat, DVM
On June 18, 2020, a White non-Hispanic man aged 67 years sought care at an emergency department (ED) in Navajo County, Arizona, complaining of dehydration, nausea, weakness, and a chronic cough of 1.5 years’ duration. He had arrived in Navajo County from Nebraska approximately 9 days earlier. On physical exam, he was tachycardic and tachypneic. His chest radiograph and computed tomographic angiography chest scan with contrast were normal, and he was discharged after receiving intravenous fluids. He returned to the ED the next day (June 19) for treatment of three red and painful suspected insect bites on his leg and was discharged the same day with a diagnosis of cellulitis and two antibiotic prescriptions (Figure). He returned to the ED the following day (June 20) complaining of fever, dizziness, productive worsening cough, “swollen glands” (location not noted), weakness, and chills. He was hospitalized and received treatment with four antibiotics for a presumptive diagnosis of sepsis. Test results of nasopharyngeal specimens collected on June 18 and June 21 were negative for SARS-CoV-2, the virus that causes COVID-19, and other respiratory pathogens. On June 24, the hospital laboratory reported an atypical gram-negative isolate from a blood specimen, which was sent that day to a commercial reference laboratory for further identification using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF). The organism was identified as Yersinia pseudotuberculosis, a gram-negative, rod-shaped organism, and reported to the hospital on June 30. The patient was discharged from the hospital on July 1 with a peripherally inserted central catheter line and 3 additional days of a 14-day course of intravenous vancomycin.
On July 10, the hospital laboratory sent a blood culture isolate to Arizona State Public Health Laboratory (ASPHL) and Yersinia pestis was presumptively identified on July 12 using reverse transcriptase polymerase chain reaction testing...
Notes from the Field: Delays in Identification and Treatment of a Case of Septicemic Plague — Navajo County, Arizona, 2020
Weekly / August 6, 2021 / 70(31);1063–1064
Ariella P. Dale, PhD; Melissa Kretschmer, MA; Irene Ruberto, PhD; David M. Wagner, PhD, Cathy Solomon; Kenneth Komatsu, MPH; Heather Venkat, DVM
On June 18, 2020, a White non-Hispanic man aged 67 years sought care at an emergency department (ED) in Navajo County, Arizona, complaining of dehydration, nausea, weakness, and a chronic cough of 1.5 years’ duration. He had arrived in Navajo County from Nebraska approximately 9 days earlier. On physical exam, he was tachycardic and tachypneic. His chest radiograph and computed tomographic angiography chest scan with contrast were normal, and he was discharged after receiving intravenous fluids. He returned to the ED the next day (June 19) for treatment of three red and painful suspected insect bites on his leg and was discharged the same day with a diagnosis of cellulitis and two antibiotic prescriptions (Figure). He returned to the ED the following day (June 20) complaining of fever, dizziness, productive worsening cough, “swollen glands” (location not noted), weakness, and chills. He was hospitalized and received treatment with four antibiotics for a presumptive diagnosis of sepsis. Test results of nasopharyngeal specimens collected on June 18 and June 21 were negative for SARS-CoV-2, the virus that causes COVID-19, and other respiratory pathogens. On June 24, the hospital laboratory reported an atypical gram-negative isolate from a blood specimen, which was sent that day to a commercial reference laboratory for further identification using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF). The organism was identified as Yersinia pseudotuberculosis, a gram-negative, rod-shaped organism, and reported to the hospital on June 30. The patient was discharged from the hospital on July 1 with a peripherally inserted central catheter line and 3 additional days of a 14-day course of intravenous vancomycin.
On July 10, the hospital laboratory sent a blood culture isolate to Arizona State Public Health Laboratory (ASPHL) and Yersinia pestis was presumptively identified on July 12 using reverse transcriptase polymerase chain reaction testing...