Mixed pneumonic plague and nosocomial MDR-bacterial infection of lung: a rare case report

Abstract

BackgroundPlague is a life-threatening disease caused by the bacterium, Yersinia pestis. Madagascar is the leading country for human plague cases worldwide. Human plague is a serious disease, particularly in its septicaemic and pneumonic forms. We report a case of pneumonic plague co-infected by a MDR-Stenotrophomonas maltophilia.Case presentationA 24 year-old man originated from Soavinandriana, a plague focus, felt uneasy and developed high fever with chills. He started treatment by himself, by private medical care and by a traditional healer for nine days moving several times from place to place. His condition had deteriorated when he presented to a district hospital with a syndrome of dyspnea, bronchial rale and altered state of consciousness. Two days later, plague diagnosis, performed as a last resort, revealed a positive F1 antigen on rapid diagnostic test. Additional tests (pla PCR and plague serology) evidenced a Y. pestis infection. However, streptomycin treatment did not achieve a complete recovery as the course of disease was complicated by the presence of MDR-S. maltophilia in his lung. This opportunistic infection could have been favored by an immunosuppression due to Y. pestis pulmonary infection and probably been acquired during his stay at a District Hospital. He was treated with a combination of ciprofloxacin and gentamycin and recovered fully.ConclusionsPneumonic plague infection may promote another virulent or avirulent bacterial infection particularly when it is not initially suspected. However, coinfection is rarely described and its occurrence frequency is unknown. In middle or low resources areas, which is the case of most plague endemic countries, control and prevention of infections in health facilities is not optimal. Co-infection with an opportunistic pathogen agent, such as S. maltophilia, is a risk which must not be disregarded as demonstrated by this case report. When deciding of a national control strategy, it should be taken into account in the choice of the first line treatment.

Trends of Human Plague, Madagascar, 1998–2016

“…Relatively low specificity (59% overall, 44.7% for PP) of the F1RDT compared with that for culture might be caused by several factors, including badly preserved and contaminated field samples and long delays in transport to laboratory; both factors could lead to negative results from culture even if the cultured material originated from a true plague case. In addition, negative culture results might have resulted from administration of antimicrobial drugs by local health officials before sampling ( 17 ), whereas F1RDT results remained positive >3 weeks after treatment initiation ( 18 ). Moreover, pain, fever, and cough are often treated with self-medication in Madagascar ( 19 ).…”

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

“…The imaging manifestations of plague are rarely reported and are not speci c. By reading a large number of literature, we summarized the following: 1) Pulmonary consolidation: Patchy, localized, or diffuse consolidation shadows appear in the lungs, with blurred edges that can merge into large areas, and may even show "white lung" changes [13]. The pathological basis of this change is diverse and may be pulmonary hemorrhage, pulmonary edema, or in ammatory exudation.…”

A Perilous Combination: Streptococcus Coinfection with Human Plague—Report of Two Cases and Review of the Literature, 1937–2022

“…There are also additional descriptions of Y. pestis coinfection with nonstreptococcal pathogens. Case reports of multidrug-resistant Stenotrophomonas maltophilia and leptospirosis coinfection with plague have been previously published, and a genomic study of a sixth-century plague victim showed evidence of invasive Haemophilus influenzae (serotype b) (Andrianaivoarimanana et al, 2018 ; Bertherat et al, 2014 ; Guellil et al, 2022 ). However, based on the available case data, Y. pestis–Streptococcus coinfection appears to carry a greater risk of mortality than other pathogens in combination with Y. pestis .…”