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A Perilous Combination: Streptococcus Coinfection with Human Plague—Report of Two Cases and Review of the Literature, 1937–2022
BACKGROUND: Plague in humans and animals is caused by Yersinia pestis, a zoonotic gram-negative bacterium endemic in certain regions of Asia, Africa, and the United States. Coinfection with both Y. pestis and Streptococci species has been anecdotally reported in humans and associated with severe and...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Mary Ann Liebert, Inc., publishers
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10512700/ https://www.ncbi.nlm.nih.gov/pubmed/37352427 http://dx.doi.org/10.1089/vbz.2022.0084 |
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author | Erly, Brian Fleck-Derderian, Shannon Cooley, Katharine M. Meyer-Lee, Kim House, Jennifer VinHatton, Elizabeth Nelson, Christina A. |
author_facet | Erly, Brian Fleck-Derderian, Shannon Cooley, Katharine M. Meyer-Lee, Kim House, Jennifer VinHatton, Elizabeth Nelson, Christina A. |
author_sort | Erly, Brian |
collection | PubMed |
description | BACKGROUND: Plague in humans and animals is caused by Yersinia pestis, a zoonotic gram-negative bacterium endemic in certain regions of Asia, Africa, and the United States. Coinfection with both Y. pestis and Streptococci species has been anecdotally reported in humans and associated with severe and rapidly fatal disease. METHODS: This report presents two cases of patients who died following Y. pestis and Streptococcus coinfection. Additional cases of previously published Y. pestis–Streptococcus coinfection were identified and reviewed using a search of electronic databases. RESULTS: The first case patient developed cough and dyspnea following 4 days of fever, malaise, and back pain and died before receiving medical care. Postmortem blood cultures were positive for Y. pestis, Streptococcus pyogenes, and Streptococcus dysgalactiae. The second case patient was hospitalized with fever, vomiting, diarrhea, and dyspnea and died of sepsis and respiratory failure on the day of admission. Y. pestis and Streptococcus pneumoniae were isolated from blood cultures drawn on admission. Seven additional cases of Y. pestis and Streptococcus coinfection were identified, dating between 1948 and 2009. These patients were healthy overall before their illness, with ages ranging from 9 to 60 years. The majority of patients had primary bubonic plague with associated pneumonia or septicemia. None of the patients who died received timely antimicrobial therapy directed against gram-negative pathogens. In every case but one, an occupational or environmental risk factor for plague was later identified. CONCLUSION: Y. pestis infection begins with a pre-inflammatory phase, during which Y. pestis and other pathogens can rapidly proliferate. Streptococci, which are frequently asymptomatic colonizers, may become invasive in this environment, leading to coinfection. The challenges of diagnosing Y. pestis in the context of coinfection may delay effective treatment. This case series and literature review illustrate the importance of clinicians remaining alert to environmental and occupational exposures in patients presenting with an infectious syndrome, especially in those who have an unexpectedly severe clinical presentation. |
format | Online Article Text |
id | pubmed-10512700 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Mary Ann Liebert, Inc., publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-105127002023-09-22 A Perilous Combination: Streptococcus Coinfection with Human Plague—Report of Two Cases and Review of the Literature, 1937–2022 Erly, Brian Fleck-Derderian, Shannon Cooley, Katharine M. Meyer-Lee, Kim House, Jennifer VinHatton, Elizabeth Nelson, Christina A. Vector Borne Zoonotic Dis Original Research BACKGROUND: Plague in humans and animals is caused by Yersinia pestis, a zoonotic gram-negative bacterium endemic in certain regions of Asia, Africa, and the United States. Coinfection with both Y. pestis and Streptococci species has been anecdotally reported in humans and associated with severe and rapidly fatal disease. METHODS: This report presents two cases of patients who died following Y. pestis and Streptococcus coinfection. Additional cases of previously published Y. pestis–Streptococcus coinfection were identified and reviewed using a search of electronic databases. RESULTS: The first case patient developed cough and dyspnea following 4 days of fever, malaise, and back pain and died before receiving medical care. Postmortem blood cultures were positive for Y. pestis, Streptococcus pyogenes, and Streptococcus dysgalactiae. The second case patient was hospitalized with fever, vomiting, diarrhea, and dyspnea and died of sepsis and respiratory failure on the day of admission. Y. pestis and Streptococcus pneumoniae were isolated from blood cultures drawn on admission. Seven additional cases of Y. pestis and Streptococcus coinfection were identified, dating between 1948 and 2009. These patients were healthy overall before their illness, with ages ranging from 9 to 60 years. The majority of patients had primary bubonic plague with associated pneumonia or septicemia. None of the patients who died received timely antimicrobial therapy directed against gram-negative pathogens. In every case but one, an occupational or environmental risk factor for plague was later identified. CONCLUSION: Y. pestis infection begins with a pre-inflammatory phase, during which Y. pestis and other pathogens can rapidly proliferate. Streptococci, which are frequently asymptomatic colonizers, may become invasive in this environment, leading to coinfection. The challenges of diagnosing Y. pestis in the context of coinfection may delay effective treatment. This case series and literature review illustrate the importance of clinicians remaining alert to environmental and occupational exposures in patients presenting with an infectious syndrome, especially in those who have an unexpectedly severe clinical presentation. Mary Ann Liebert, Inc., publishers 2023-07-01 2023-07-11 /pmc/articles/PMC10512700/ /pubmed/37352427 http://dx.doi.org/10.1089/vbz.2022.0084 Text en © Brian Erly et al. 2023; Published by Mary Ann Liebert, Inc. https://creativecommons.org/licenses/by/4.0/This Open Access article is distributed under the terms of the Creative Commons License [CC-BY] (http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Research Erly, Brian Fleck-Derderian, Shannon Cooley, Katharine M. Meyer-Lee, Kim House, Jennifer VinHatton, Elizabeth Nelson, Christina A. A Perilous Combination: Streptococcus Coinfection with Human Plague—Report of Two Cases and Review of the Literature, 1937–2022 |
title | A Perilous Combination: Streptococcus Coinfection with Human Plague—Report of Two Cases and Review of the Literature, 1937–2022 |
title_full | A Perilous Combination: Streptococcus Coinfection with Human Plague—Report of Two Cases and Review of the Literature, 1937–2022 |
title_fullStr | A Perilous Combination: Streptococcus Coinfection with Human Plague—Report of Two Cases and Review of the Literature, 1937–2022 |
title_full_unstemmed | A Perilous Combination: Streptococcus Coinfection with Human Plague—Report of Two Cases and Review of the Literature, 1937–2022 |
title_short | A Perilous Combination: Streptococcus Coinfection with Human Plague—Report of Two Cases and Review of the Literature, 1937–2022 |
title_sort | perilous combination: streptococcus coinfection with human plague—report of two cases and review of the literature, 1937–2022 |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10512700/ https://www.ncbi.nlm.nih.gov/pubmed/37352427 http://dx.doi.org/10.1089/vbz.2022.0084 |
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