<i>Notes from the Field</i>: Delays in Identification and Treatment of a Case of Septicemic Plague — Navajo County, Arizona, 2020

Dale, Ariella P.; Kretschmer, Melissa; Wagner, David M.; Solomon, Cathy; Komatsu, Kenneth; Venkat, Heather

doi:10.15585/mmwr.mm7031a1

Cited by 4 publications

(1 citation statement)

References 4 publications

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“…Lymphadenopathy with necrosis: Multiple irregularly enlarged lymph nodes can form, with low-density areas inside [14]. 4)Cellulitis: Cellulitis is a severe complication of plague, characterized by subcutaneous soft tissue swelling in the affected area, forming multiple high-density honeycomb-like ocs shadows [15].…”

Section: Discussionmentioning

confidence: 99%

Imaging analysis of pneumonic plague infection in Xizang, China: two case reports and literature review

Wang,

Li,

et al. 2024

Preprint

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Background Plague is an acute infectious disease caused by the Yersinia pestis. Historically, it has been a major pandemic with high mortality rates, known as the "Black Death" in the 14th century, which resulted in millions of deaths in Europe. With increasing economic prosperity, more and more people are traveling to Xizang. However, this trend also hides significant safety hazards. Currently, there are few recent reports on plague, especially those with imaging manifestations available. In this study, we report the detailed clinical and radiographic data of two patients with pneumonic plague in Xizang, China, in 2023. Case presentation: We report two cases of pulmonary plague in Xizang, with both patients were herdsmen living in an area where dead marmots were found. Both patients presented with symptoms such as fever, hemoptysis, dyspnea and coma. Chest computed tomography (CT) scans showed multiple nodules distributed in the central regions of lung lobes, consolidation distributed in secondary pulmonary lobules, and had a gravity-dependent distribution pattern. One patient developed pleural effusion. These imaging findings are consistent with pulmonary hemorrhage and diffuse alveolar damage. Despite emergency treatment, both patients died within 24 hours of admission. Through retrospective medical history investigation and autopsy, the final diagnosis was confirmed as pulmonary plague. Conclusion Pneumonic plague is the most deadly infectious disease, and its pathological features are mainly include damage to the alveoli, pulmonary hemorrhage, and pulmonary edema. Corresponding to CT, it manifests as acute and rapidly progressing pneumonia, alveolar damage, and pulmonary hemorrhage. The value of this article lies in the completeness and typicality of the imaging data, vivid hand-drawn illustrations of transmission pathways, and comprehensive literature review, all of which serve to enhance public understanding of plague and play an important warning role.

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Section: Discussionmentioning

confidence: 99%

Imaging analysis of pneumonic plague infection in Xizang, China: two case reports and literature review

Wang,

Li,

et al. 2024

Preprint

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A systematic review of the clinical profile of patients with bubonic plague and the outcome measures used in research settings

Bourner,

Andriamarohasina,

Salam

et al. 2023

Preprint

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Background: Plague is a zoonotic disease that, despite affecting humans for more than 5000 years, has historically been the subject of limited drug development activity. Drugs that are currently recommended in treatment guidelines have been approved based on animal studies alone – no pivotal clinical trials in humans have yet been completed. As a result of the sparse clinical research attention received, there are a number of methodological challenges that need to be addressed in order to facilitate the collection of clinical trial data that can meaningfully inform clinicians and policy-makers. One such challenge is the identification of clinically-relevant endpoints, which are informed by understanding the clinical characterisation of the disease – how it presents and evolves over time, and important patient outcomes, and how these can be modified by treatment. Methodology/ Principal findings: This systematic review aims to summarise the clinical profile of 1343 patients with bubonic plague described in 87 publications, identified by searching bibliographic databases for studies that meet pre-defined eligibility criteria. The majority of studies were individual case reports. A diverse group of signs and symptoms were reported at baseline and post-baseline timepoints – the most common of which was presence of a bubo, for which limited descriptive and longitudinal information was available. Death occurred in 15% of patients; although this varied from an average 10% in high-income countries to an average 17% in low- and middle-income countries. The median time to death was 1 day, ranging from 0 to 16 days. Conclusions/ Significance: This systematic review elucidates the restrictions that limited disease characterisation places on clinical trials for infectious diseases such as plague, which not only impacts the definition of trial endpoints but has the knock-on effect of challenging the interpretation of a trial’s results. For this reason and despite interventional trials for plague having taken place, questions around optimal treatment for plague persist.

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Imaging analysis of pneumonic plague infection in Xizang, China: a case report and literature review

Wang,

Li,

et al. 2024

BMC Pulm Med

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Background Plague is an acute infectious disease caused by the Yersinia pestis. Historically, it has been a major pandemic with high mortality rates, known as the “Black Death” in the 14th century, which resulted in millions of deaths in Europe. With increasing economic prosperity, more and more people are traveling to Xizang. However, this trend also hides significant safety hazards. Currently, there are few recent reports on plague, especially those with imaging manifestations available. In this study, we report the detailed clinical and radiological data of the patient with pneumonic plague in Xizang, China, in 2023. Case presentation We report a case of pneumonic plague in Xizang, which occurred in a herdsman living in an area where dead marmots were found. The patient presented with symptoms such as fever, hemoptysis, dyspnea and coma. Chest computed tomography (CT) scans showed multiple nodules distributed in the central regions of lung lobes, consolidation distributed in secondary pulmonary lobules, and had a gravity-dependent distribution pattern. These imaging findings were consistent with pulmonary hemorrhage and diffuse alveolar damage. Despite emergency treatment, the patient died within 48 h of admission. Through retrospective medical history investigation, laboratory examination and autopsy, the final diagnosis was confirmed as pneumonic plague. Conclusion Pneumonic plague is the most deadly infectious disease, and its pathological features mainly include damage to the alveoli, pulmonary hemorrhage, and pulmonary edema. Corresponding to CT, it manifests as acute and rapidly progressing pneumonia, alveolar damage, and pulmonary hemorrhage. The value of this article lies in the completeness and typicality of the imaging data, vivid hand-drawn illustrations of transmission pathways, and comprehensive literature review, all of which serve to enhance public understanding of plague and play an important warning role.

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Notes from the Field: Delays in Identification and Treatment of a Case of Septicemic Plague — Navajo County, Arizona, 2020

Cited by 4 publications

References 4 publications

Imaging analysis of pneumonic plague infection in Xizang, China: two case reports and literature review

Imaging analysis of pneumonic plague infection in Xizang, China: two case reports and literature review

A systematic review of the clinical profile of patients with bubonic plague and the outcome measures used in research settings

Imaging analysis of pneumonic plague infection in Xizang, China: a case report and literature review

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