Two cases of imported pneumonic plague in Beijing, China.

INTRODUCTION: Plague is an acute, often fulminating infectious disease caused by Yersinia Pestis transmitted by rodents. It is rarely encountered in clinics, although natural plague foci are widely distributed around the world. PATIENT CONCERNS: A couple who are cattle and sheep herdsmen from the Inner Mongolia Autonomous Region presented with cough, expectoration and fever. The husband developed sudden onset of fever and bloody sputum after working the soil on his farm. The wife also developed fever after nursing his husband. Both patients were preliminarily diagnosed with severe pneumonia, but antimicrobial treatments in the local hospital were unsuccessful. Their conditions deteriorated and they were transferred to our center. DIAGNOSIS: Preliminary etiological examinations were unremarkable, while blood and sputum specimens were found to be positive by RT-PCR and colloidal gold-immunochromatography assay targeting the F1 antigen and by reverse indirect hemagglutination assay. Pneumonic plague was confirmed. INTERVENTIONS: Both patients were transferred to special infectious disease hospital for further treatment. OUTCOMES: The condition of the female patient deteriorated. The male recovered after treatment, while the female patient finally died. CONCLUSION: There are 3 main forms of plague: bubonic, pneumonic and septicemic. Humans can be infected by the bites of bacterium-bearing fleas or direct contact of wild animals that died from plague. Human plague can be transmitted by close contact through coughing droplet. Neglected diagnosis of plague could cause severe consequences. Strict surveillance and protection measures should be taken and the public should be alerted about potential risks when epizootic plague is detected.

Semiautomated Magnetic Resonance Imaging Assessment of Carotid Plaque Lipid Content.

BACKGROUND: The composition of a carotid plaque is important for plaque vulnerability and stroke risk. The main aim of this study was to assess the potential of semiautomated segmentation of carotid plaque magnetic resonance imaging (MRI) in the assessment of the size of the lipid-rich necrotic core (LRNC). METHODS: Thirty-four consecutive patients with carotid stenosis of 70% or higher, who were scheduled for carotid endarterectomy, underwent a clinical neurological examination, Color duplex ultrasound, 3-T MRI with an 8-channel carotid coil, and blood tests. All examinations were performed less than 24 hours prior to surgery and plaques were assessed histologically immediately following endarterectomy. Plaques were defined as symptomatic when associated with ipsilateral cerebral ischemic symptoms within 30 days prior to inclusion. The level of agreement between the size of the LRNC and calcification on MRI to the histological estimation of the same tissue components, plaque echolucency on ultrasound, and symptoms was assessed. RESULTS: The size of the LRNC on MRI was significantly correlated to the percentage amount of lipid per plaque on histological assessment (P = .010, r = .5), and to echogenicity on ultrasound with echolucent plaques having larger LRNC than echogenic plaques (P = .001, r = -.7). CONCLUSIONS: In this study, we found that semiautomated MRI assessments of the percentage LRNC in carotid plaques were significantly correlated to the percentage LRNC per plaque on histological assessment, and to echogenicity on ultrasound with echolucent plaques having larger LRNC than echogenic plaques.

Cat-transmitted fatal pneumonic plague in a person who traveled from Colorado to Arizona.

Plague, primarily a disease of rodents and their infected fleas, is fatal in 50% of infected humans if untreated. In the United States, human cases have been concentrated in the southwest. The most common modes of plague transmission are through flea bites or through contact with infected blood or tissues; however, primary pneumonic plague acquired from cats has become increasingly recognized. We report on the case investigation of a patient, presumably exposed to a plague-infected cat in Colorado, who presented with gastrointestinal symptoms, and subsequently died of primary pneumonic plague. Public health officials should be vigilant for plague activity in rodent populations, veterinarians should suspect feline plague in ill or deceased cats, and physicians should have a high index of suspicion for plague in any person who has traveled to plague enzootic areas.

Imaging in plague.

An 8-year-old boy presented with elevated temperature, malaise, hepatosplenomegaly, mesenteric adenitis, and septic shock. Cultures of biopsied abdominal lymph nodes as well as the blood grew Yersinia pestes. The boy's condition improved after two weeks of chloramphenicol and cefotaxime (Claforan). Two days after stopping intravenous antibiotic therapy, the patient again became febrile and complained of abdominal pain. Abdominal imaging with 111In-labeled leukocytes did not show any abnormalities, however, 67Ga-citrate scintigraphy demonstrated an abnormal focus of increased radiopharmaceutical uptake within a confluence of necrosed lymph nodes within the right upper quadrant of the abdomen. In addition, abnormal 67Ga-uptake was seen within the left hip region. Correlative imaging with computed tomography is also presented.

Radiographic manifestations of plaque in New Mexico, 1975-1980. A review of 42 proved cases.

The radiographic findings in 42 proved cases of plague are examined. There was a high association between bilateral alveolar infiltrates and secondary pneumonic plague; however, these findings were not completely specific, as they were also seen in some patients who had disseminated intravascular coagulation or shock lung, In an endemic area and in the proper clinical setting, any patient with bilateral alveolar infiltrates should be considered to have secondary pneumonic plague until proved otherwise.