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Food & Health : Agri. & Environ. Last Updated: Apr 20, 2011 - 9:38:09 AM


Arizona man likely dies of plague, what you need to know
By Sue Mueller
Nov 10, 2007 - 10:38:42 AM

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photo: CDC
SATURDAY NOV. 10, 2007 (Foodconsumer.org) -- An Arizona-based wildlife biologist working for the National Park Service likely died of plague, officials from Grand Canyon National Park announced on Friday.

Eric York, 37, who was found dead in his home on November 2, was found to have plague in his body, according to an autopsy report.

As a precaution, 49 of York's coworkers and others who had come near him were placed on antibiotics.  Officials said no symptoms manifested in any of these individuals on medication.

York probably got infected with the plague bacteria when he performed a necropsy on a mountain lion that likely died of the infection, according to officials.

Flu-like symptoms in York showed up as early as Oct 30, three days after the mountain lion autopsy.  He went to Grand Canyon Clinic, but was sent home the same day. It is not known he was given any antibiotics.

Officials said the symptoms of plague are difficult to detect and are easily confused with the flu.

The following fact sheet and common questions and answers about plague are cited from the Centers for Disease Control and Prevention for those who'd like to know more about the infection.

Plague Fact Sheet


CLINICAL FEATURES

Bubonic plague: enlarged, tender lymph nodes, fever, chills and prostration
Septicemic plague: fever, chills, prostration, abdominal pain, shock and bleeding into skin and other organs
Pneumonic plague: fever, chills, cough and difficulty breathing; rapid shock and death if not treated early

ETIOLOGIC AGENT

Yersinia pestis - bacillus

INCIDENCE

In the U.S., 1 to 40 cases reported annually (avg = 13 cases) by western states, 1971-1995
Worldwide, 2861 cases reported by 10 countries to WHO in 1995

SEQUELAE

Rare, consequences of disseminated intravascular coagulation, lung damage
Mortality 50-90% if untreated; 15% when diagnosed and treated

COSTS

Not known

TRANSMISSION

Flea-borne, from infected rodents to humans
Direct contact with infected tissues or fluids from handling sick or dead animals
Respiratory droplets from cats and humans with pneumonic plague

RESERVOIRS

Primarily wild rodents in U.S. (especially rock squirrels, ground squirrels, prairie dogs, other burrowing rodents)
Commensal rats may be important elsewhere

RISK GROUPS

In the U.S., persons exposed to rodent fleas, wild rodents, or other susceptible animals in enzootic areas of western states
Most cases occur in southwestern states of NM, AZ, CO, and in CA
Highest rates in Native Americans, especially Navajos; other risk groups: hunters; veterinarians and pet owners handling infected cats; campers or hikers entering areas with outbreaks of animal plague


Questions and Answers About Plague  


Q. How is plague transmitted?
A. By fleas that become infected with bacteria Yersinia pestis that cause plague.

Q. How do people get plague?
A. By the bite of fleas infected with the plague bacteria.


Prairie dogs can harbor fleas infected with plague bacteria.
 
Q. What is the basic transmission cycle?
A. Fleas become infected by feeding on rodents, such as the chipmunks, prairie dogs, ground squirrels, mice, and other mammals that are infected with the bacteria Yersinia pestis. Fleas transmit the plague bacteria to humans and other mammals during the feeding process. The plague bacteria are maintained in the blood systems of rodents.
Q. Could you get plague from another person?
A. Yes, when the other person has plague pneumonia and coughs droplets containing the plague bacteria into air that is breathed by a non-infected person.

Q. What are the signs and symptoms of plague?
A. 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" (hence the term "bubonic plague"). 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.

Q. What is the incubation period for plague?
A. 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. When 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 expel bloody sputum. If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death.

Q. What is the mortality rate of plague?
A. About 14% (1 in 7) of all plague cases in the United States are fatal.

Q. How many cases of plague occur in the U.S.?
A. Human plague in the United States has occurred as mostly scattered cases in rural areas (an average of 10 to 20 persons each year). Globally, the World Health Organization reports 1,000 to 3,000 cases of plague every year.

Q. How is plague treated?
A. According to treatment experts, a patient diagnosed with suspected plague should be hospitalized and medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of lymph gland, blood, and sputum samples. Antibiotic treatment should begin as soon as possible after laboratory specimens are taken. Streptomycin is the antibiotic of choice. Gentamicin is used when streptomycin is not available. Tetracyclines and chloramphenicol are also effective. Persons who have been in close contact with a plague patient, particularly a patient with plague pneumonia, should be identified and evaluated. The U.S. Public Health Service requires that all cases of suspected plague be reported immediately to local and state health departments and that the diagnosis be confirmed by CDC. As required by the International Health Regulations, CDC reports all U.S. plague cases to the World Health Organization.

Q. Is the disease seasonal in its occurrence?
A. No, plague can be acquired at anytime during the year.

Q. Where is plague most common?
 A. Click on the map at right that shows reported cases of human plague between 1970-1997 by patient's county of residence. Generally, plague is most common in the southwestern states, particularly New Mexico and Arizona.


Q. Who is at risk for getting plague?
A. Outbreaks in people occur in areas where housing and sanitation conditions are poor. These outbreaks can occur in rural communities or in cities. They are usually associated with infected rats and rat fleas that live in the home.





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