Bubonic Plague, ex New Mexico, New York City

[Reasonable Rascal]

http://abclocal.go.com/wabc/news/WABC_110602_nycplague.html

NYC Medical Scare: Two Being Treated At Area Hospital For Bubonic Plague

(New York-WABC, November 6, 2002) - Two patients at a New York City hospital have been diagnosed with a dangerous disease not seen in this region in decades. Eyewitness News has learned that doctors at Beth Israel Medical Center are caring for the two people who have the Bubonic plague. Jim Dolan reports from Beth Israel with more.

The Bubonic plague claimed millions of lives in Europe and Asia in the Middle Ages. Now sources confirm for Eyewitness News the probable presence of the plague in two patients here in New York. The pair is a married couple from New Mexico who were in the city on vacation.

Doctors tell Eyewitness News that a microbiology test confirmed their fears that the couple was indeed suffering from the Bubonic plague. The couple has been isolated to prevent the further spread of the disease.

Doctors say while the female patient is out of danger, her husband is in extremely critical condition. They say he was admitted with a fever of 105 degrees. High fever is one of the symptoms of the Bubonic plague.

The city and state health department were joined by the Centers for Disease Control in their investigation into how the couple contracted the disease. The state health department in Sante Fe, New Mexico, where the couple lives, tested rodents on their property this summer. Apparently many of those rodents tested positive for the Bubonic plague.

Doctors say they believe the couple was infected in their home state after sleeping in a sleeping bags that had been outdoors on their property for several weeks. Those sleeping bags are now being tested.

Officials say there are 20 to 30 cases of Bubonic plague worldwide each year. If caught early, the disease is very treatable, but it is often mistaken for a cold. If treatment is delayed, the plague can, of course, be fatal. ---------------------------------------
PROGNOSIS

[Half of bubonic plague victims die if not treated, and almost all victims of pneumonic plague die if not treated. Treatment reduces the death rate to 5 percent.

Source: National Institutes Of Health] Edit: RR

[Reasonable Rascal]

I should add while I think of it that Bubonic Plague is not altogether unknown in the US, though rather rare in humans. Prarie dogs are common harbors of this disease and it is not unknown for entire colonies to be wiped out by same. Besides New Mexico, obviously, other southwestern states as well as the California foothills in the southern part of the state also have endemic Plague as a naturally ocurring phenomenon.

RR

[Reasonable Rascal]

A later report repeating the above from ProMED, with a request for more info if possible. Added to this thread for the additional info.

RR
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PRO/AH/EDR> Plague, bubonic - USA (New York City ex New Mexico)
Date: Wed, 6 Nov 2002 21:52:04 -0500 (EST)
From: ProMED-mail <promed@promed.isid.harvard.edu

[Assuming that there has been a microbiological confirmation, it is highly likely that the couple acquired
plague while at home in New Mexico in the American Southwest where the disease has been identified in animals as well as humans (see prior ProMED-mail postings listed below). It is bothersome that the clinical description available at this time does not specifically mention the presence of a bubo - the characteristic swollen lymph gland. If it was truly absent and one or both of the couple had a
pneumonia-like presentation, the diagnosis of pneumonic plague should be considered. _Yersinia pestis_ (the organism responsible for plague) is a class A biologic agent. Concern of a possible intentional infection would be raised if these cases had occurred in a couple that had not had exposure in a known endemic area.

Although the bubonic form of plague does not spread from person-to-person, both primary pneumonic plague (spread directly from an aerosol) and secondary pneumonic plague (spread to the lung via the bloodstream from the infected lymph node) can be transmitted from person-to-person.

More information on these cases would be appreciated. - Mods.LL/MPP]

[Reasonable Rascal]

PLAGUE, BUBONIC - NEW YORK CITY ex NEW MEXICO (02)
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A ProMED-mail post

[1]
Date: 6 Nov 2002
From: New York City Department of Health & Mental Hygiene
Source: New York City Department of Health & Mental Hygiene Alert

Two cases of travel-associated bubonic plague in New York City
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The New York City Department of Health and Mental Hygiene (NYC DOHMH) has presumptively diagnosed bubonic plague in a 53-year-old male resident of New Mexico who was visiting New York City. In addition, the patient's 47-year-old wife has symptoms consistent with bubonic plague and laboratory
test results are pending.

Both patients reside in Santa Fe County, New Mexico - in an area that is known to be an enzootic focus for plague. The source of these patients' infections is suspected to be rodents and rodent fleas near their home, as a woodrat that was found in the patients' back yard this past July tested positive for plague. Fleas taken from this woodrat also tested positive for plague.

This couple traveled to New York City on November 1, 2002 and both developed a flu-like illness on November 3rd. As symptoms continued to worsen, they were admitted to a hospital on November 5th and on examination both had fever and swollen, tender inguinal lymph nodes ("buboes"). A blood culture on the male patient tested positive at the NYC DOHMH's Public Health Laboratory this evening for Yersinia pestis by both polymerase chain reaction and direct fluorescent antibody testing. Further confirmatory tests will be performed by the Centers for Disease Control and Prevention (CDC). Laboratory tests on the female patient are still pending, but her clinical presentation is consistent with bubonic plague. Both patients are being treated with aminoglycosides and doxycycline. The 53-year-old male, who is also diabetic, is in critical condition with a secondary septicemia and multi-system failure; the 47-year-old female is stable.

All epidemiologic evidence suggests that these infections were naturally acquired in New Mexico. Although the exact source of exposure for these patients is not yet known, most human plague cases are due to bites from plague-infected fleas around the home. The usual incubation period for plague is between 2 to 7 days. As these patients became ill within 48 hours of their arrival in New York City, their exposure occurred in New Mexico. Since Y. pestis was isolated recently from fleas on their property, this is the location where they probably were infected. The New Mexico Department of Health and the CDC are currently conducting an environmental investigation in the area around these patients' home to assess potential sources of exposure.

As neither patient had symptoms or radiographic evidence of pneumonia, antibiotic prophylaxis has not been recommended for any hospital or social contacts. Laboratory staff handling specimens from these patients have been instructed to follow Biosafety Level 2 precautions.

Naturally occurring plague is a disease primarily affecting rodents, and transmission between rodents is via infected fleas. In the United States, bubonic plague is transmitted to humans through the bites of infected fleas; bubonic plague is not transmitted person to person. Pneumonic plague is transmitted after plague bacilli are inhaled following direct contact with infected animals, including rodents, wildlife and pets (cats and dogs) or via droplet transmission from a patient with pneumonic plague.

Bubonic plague symptoms in humans include fever; painful swollen lymph nodes in the groin, armpit or neck areas; chills; and headache, vomiting, and diarrhea. Patients may develop secondary septicemic plague or pneumonic plague; pneumonic plague can be spread person-to-person. With prompt diagnosis and appropriate antibiotic treatment and supportive care, most patients with bubonic plague survive.

Human plague has been reported most often from the four western states of Arizona, California, Colorado and New Mexico. Wild rodents, especially ground squirrels and prairie dogs, are the natural reservoir for the plague bacterium. Since January 1980, there have been 272 cases of plague reported in the United States; the overwhelming majority of cases were bubonic plague. Of these, 143 (53%) were acquired in New Mexico. Plague is not enzootic in the eastern United States; there has not been a case of plague in New York City in at least 100 years.

Useful websites for additional information on plague include:

Centers for Disease Control and Prevention
<www.bt.cdc.gov/agent/plague/index.asp>

Johns Hopkins Center for Civilian Biodefense Strategies
<www.hopkins-biodefense.org/pages/agents/tocplague.html>

Center for Infectious Disease Research and Policy
<www1.umn.edu/cidrap/content/bt/plague/ >

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New York City Department of Health & Mental Hygiene