Becker's Clinical Quality & Infection Control

6 INFECTION CONTROL Arizona man diagnosed with the plague after 1 month of symptoms, CDC report finds By Erica Carbajal 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. e man reported glove handling a dead pack rat before symptom onset and has since recovered. e 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, com- plaining of dehydration, nausea, weakness and a chronic cough, according to the report. He was treated with IV fluids and dis- charged. e 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. e patient again returned to the ED June 20 with additional symptoms including a fever, dizziness, a worsening cough and "swollen glands." is time, it was assumed he had sepsis and was treated with four antibiotics. e 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. e patient was then discharged and prescribed a two- week IV treatment. e diagnosis was still incorrect. e hospital sent a blood culture to the state's health department on July 10. e health department detected Yersinia pestis — the bacterium that causes plague — July 15 and confirmed the patient's diagnosis as septice- mic 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. Bubon- ic plague typically affects the lymph nodes, while pneumonic plague develops from inhal- ing infectious droplets, or from an untreated case of the other types of plague. While the state's health department requires hos- pitals 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 misidentifica- tion of the pathogen and delays in laboratory reporting," the CDC report said. "is pa- tient did not receive high-efficacy antibiotic treatment, a tetracycline, until approximately 30 days aer symptom onset; he recovered, possibly in part because he received antibiot- ics with some demonstrated efficacy against Y. pestis, including trimethoprim/sulfame- thoxazole, 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. n Michigan warns clinicians of 569% jump in Legionnaires' cases By Mackenzie Bean T he Michigan Department of Health and Human Services urged healthcare providers in the state to remain vigilant amid a significant spike in Legionnaires' cases this summer. The department identified 107 Legionnaires' cases in 25 counties be- tween July 1 and July 14. This figure marks a 569 percent increase from the 16 cases reported in the same period last year and a 169 percent increase from the 41 cases reported in the same period of 2019. Legionnaires' disease is contracted when water droplets containing Legionella bacteria are inhaled. The department said environmental factors may be contributing to the increase, which is higher than expected for this time of year. "Recent weather trends including rain, flooding and warmer weather may be playing a role in the rise of reported legionellosis cases this summer," Joneigh Khaldun, MD, the health department's chief medi- cal executive, said in a July 19 news release. "We ask that healthcare providers remain vigilant and test and treat appropriately." The department notified clinicians about the jump in cases this sum- mer and shared relevant information. As of July, health officials had not found a common source of the infections. n Georgia hospital deploys UV light disinfection robots By Mackenzie Bean E lbert Memorial Hospital has tapped two sanitizing robots to help disinfect its facilities, the organization said Aug. 17. The robot emits broad spectrum ultraviolet light to quickly destroy microorganisms on hospital surfaces and can deactivate SARS- CoV-2 — the virus that causes COVID-19 — in two minutes. Elbert Memorial said environmental services staff are able to disinfect dozens of patient rooms per day with each robot. They are also being used to disinfect patient care areas, operating rooms, public restrooms and offices. Elbert Memorial is a 25-bed critical access hospital in Elberton, Ga. n

• Cover