MMWR News Synopsis

Friday, August 6, 2021

Notes from the Field

Delays in identification of a rare case of plague in Navajo County, Arizona, resulted in the patient not receiving the best treatment until about 30 days after he sought care at an emergency department. Timely identification of a disease-causing bacteria and treatment of the patient are critical to public health response and investigation of highly infectious pathogens such as Y. pestis, the bacterium that causes plague. On June 24, 2020, a hospital laboratory in Navajo County, Arizona, reported an unusual bacterial sample found in a 67-year-old man who had been hospitalized with sepsis on June 20. The sample was sent to a commercial reference laboratory, where it was initially identified as Yersinia pseudotuberculosis, and was reported to the hospital on June 30. The patient was discharged from the hospital on July 1 with three additional days of a 14-day course of vancomycin, an antibiotic. On July 10, the hospital laboratory sent a blood culture isolate to Arizona State Public Health Laboratory and Yersinia pestis was identified on July 13. After culture confirmation of Y. pestis on July 15 and classification of the case as septicemic plague, a 10-day course of oral doxycycline was prescribed and completed; however, the patient had already recovered. Delays in identification of the isolate as Y. pestis were attributed to initial misidentification of the pathogen and delays in laboratory reporting. Plague is rare in Arizona and was last reported in 2017 in a Navajo County resident. With rare pathogens, particularly in the context of the COVID-19 pandemic, timely laboratory identification is crucial for appropriate clinical diagnosis and treatment. This patient did not receive the best antibiotic treatment until approximately 30 days after he presented with symptoms to the emergency department. He recovered, possibly in part because he received antibiotics with some demonstrated effectiveness against Y. pestis early in the illness.



CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

Page last reviewed: August 4, 2021