A 67-year-old man experiencing symptoms for one month was later diagnosed with septicemic plague, according to the CDC's Aug. 6 Morbidity and Mortality Weekly report.
The man reported glove handling a dead pack rat before symptom onset and has since recovered. The plague is rare, with this marking Arizona's first case since 2017, according to the CDC.
On June 18, the patient went to a Navajo County, Ariz., emergency department, complaining of dehydration, nausea, weakness and a chronic cough, according to the report. He was treated with IV fluids and discharged. The next day, the patient returned with three red and painful bumps on his leg that were assumed to be bug bites. He was diagnosed with cellulitis, prescribed two antibiotics and discharged.
The patient again returned to the ED June 20 with additional symptoms including a fever, dizziness, a worsening cough, and "swollen glands." This time, it was assumed he had sepsis and was treated with four antibiotics. The individual tested negative for COVID-19 twice while in the hospital.
On June 30, a hospital lab-tested blood sample from the patient detected Yersinia pseudotuberculosis — a close relative to the bacterium that causes the plague. The patient was then discharged and prescribed a two-week IV treatment.
The diagnosis was still incorrect. The hospital sent a blood culture to the state's health department on July 10. The health department detected Yersinia pestis — the bacterium that causes plague — July 15 and confirmed the patient's diagnosis as septicemic plague, according to the report, which added the patient was ultimately treated with a 10-day course of the antibiotic doxycycline.
Septicemic plague is one of three forms of the disease. Symptoms associated with this form of the plague include fever, chills, extreme weakness, abdominal pain, shock and possible bleeding into the skin or other organs. Bubonic plague typically affects the lymph nodes, while pneumonic plague develops from inhaling infectious droplets, or from an untreated case of the other types of plague.
While the state's health department requires hospitals to submit samples of any bacterium with Yersinia genus within one business day, a 10-day delay in submission occurred in this case.
"Delays in identification of the isolate as Y. pestis were attributed to initial misidentification of the pathogen and delays in laboratory reporting," the CDC report said. "This patient did not receive high-efficacy antibiotic treatment, a tetracycline, until approximately 30 days after symptom onset; he recovered, possibly in part because he received antibiotics with some demonstrated efficacy against Y. pestis, including trimethoprim/sulfamethoxazole, early in the illness course."
People may catch bubonic or septicemic plague through fleabites, or exposure to the tissue or body fluids of infected animals, according to the CDC.