Persistent Yersinia pestis antigens in ischemic tissues of a patient with septicemic plague.
In November 2002, a couple from New Mexico traveled to New York where both had fever and unilateral inguinal adenopathy. The husband was in septic shock when he sought medical care and was admitted to an intensive care unit, where he developed ischemic necrosis of his feet which later required bilateral amputation. Yersinia pestis was grown from his blood. Immunohistochemical assays using anti-Y pestis antibodies demonstrated multiple bacteria and granular antigens in and around vessels of the ischemic amputation tissues obtained 20 days after initiation of antibiotics; however, no evidence of Y pestis was present in viable tissues. Immunohistochemical evidence of Y pestis inside vessels of gangrenous feet in this patient underscores the importance of adequate excision of necrotic or partially necrotic tissues because antibiotics cannot be effectively delivered to necrotic and poorly perfused tissues.
Guarner
Jeannette
J
Infectious Diseases Pathology Activity, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. jguarner@cdc.gov
Shieh
Wun-Ju
WJ
Chu
May
M
Perlman
David C
DC
Kool
Jacob
J
Gage
Kenneth L
KL
Ettestad
Paul
P
Zaki
Sherif R
SR
D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000032:analysis; D017719:Diabetic Foot / Q000150:complications / Q000473:pathology / Q000601:surgery; D005528:Foot / Q000098:blood supply / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007511:Ischemia / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D010930:Plague / Q000276:immunology / Q000473:pathology*; D012772:Shock, Septic / Q000150:complications / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D015007:Yersinia / Q000276:immunology / Q000302:isolation & purification* / Q000472:pathogenicity
D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial