Rare case of pneumonic plague in US - Arizona

[Astronuc]

A northern Arizona (in or near Flagstaff, AZ) resident has died from a case of pneumonic plague
https://apnews.com/article/pneumonic-plague-death-arizona-2c32ed6bd4a86be3d38828fe69aeb68b

FLAGSTAFF, Ariz. (AP) — A resident of northern Arizona has died from pneumonic plague, health officials said Friday.

Plague is rare to humans, with on average about seven cases reported annually in the U.S., most of them in the western states, according to federal health officials.

The death in Coconino County, which includes Flagstaff, was the first recorded death from pneumonic plague since 2007, local officials said. Further details including the identify of the victim were not released.


The bubonic plague is the most common form of the bacterial (Yersinia pestis) infection, which spreads naturally among rodents like prairie dogs and rats.

There are two other forms: septicemic plague that spreads through the whole body, and pneumonic plague that infects the lungs.

https://en.wikipedia.org/wiki/Yersinia_pestis

An average of seven human plague cases are reported each year in the US, the Centers for Disease Control and Prevention says.
https://www.bbc.com/news/articles/cz7l8w8881qo

Plague death confirmed in Coconino County
https://ein.az.gov/plague-death-confirmed-coconino-county

Due to the endemic nature of plague in the southwest United States, CCHHS maintains a surveillance system for the disease. CCHHS also conducts surveillance for other endemic diseases, including West Nile virus, hantavirus, and rabies, to rapidly detect disease, understand its spread, and implement control measures to protect the public.

https://time.com/7301920/pneumonic-plague-arizona-death/

According to the CDC, U.S. officials have not documented person-to-person spread of plague in the country since 1924, but “there continue to be rare cases of pneumonic plague among people exposed to sick cats.” Cats, the CDC said on its website, “are particularly susceptible to plague and can be infected by eating infected rodents.”

 

[sbrothy]

I was under the impression that bubonic plague was treatable with antibiotics:

Treatment of bubonic plague with sulfonamides and antibiotics

 

[BillTre]

I was under the impression that bubonic plague was treatable with antibiotics:

Treatment of bubonic plague with sulfonamides and antibiotics

It is as I understand things.
Should work on both bubonic and pneumonic plagues (same species and presumably same susceptibility to antibiotics.
This is quite different from the plagues of the middle (?) ages. No antibiotics back then. High lethality without antibiotics.
The pneumonic form is more transmissible because it bypasses the rodents and fleas.

 

[sbrothy]

It is as I understand things.
Should work on both bubonic and pneumonic plagues (same species and presumably same susceptibility to antibiotics.
This is quite different from the plagues of the middle (?) ages. No antibiotics back then. High lethality without antibiotics.
The pneumonic form is more transmissible because it bypasses the rodents and fleas.

Yeah, that was tough times. Not only no antibiotics but I'm sure tetanus was no fun either. Not to mention polio, leprosy and what had we. We're lucky to be born in these times. I'm not even sure it's gonna get better.

 

[pinball1970]

Yeah, that was tough times. Not only no antibiotics but I'm sure tetanus was no fun either. Not to mention polio, leprosy and what had we. We're lucky to be born in these times. I'm not even sure it's gonna get better.

Much closer than the middle ages too, pre vaccination and antibiotics polio, diphtheria, scarlet fever and TB all killers up to the 1960s in the UK.
Plague is not one we want see stage a major come back.

 

[sbrothy]

Much closer than the middle ages too, pre vaccination and antibiotics polio, diphtheria, scarlet fever and TB all killers up to the 1960s in the UK.
Plague is not one we want see stage a major come back.

Absolutely not, and it's probably also (thank to any higher powers that may be) very unlikely. But in this day and age with the vaccine skepticism one can only wonder which already virtually eradicated malady we'll see make a "comeback". *shudders*.

 

[sbrothy]

I was under the impression that bubonic plague was treatable with antibiotics:

Treatment of bubonic plague with sulfonamides and antibiotics

Wow, I just read the abstract from the paper I posted more closely and found this glaring back at me: ”[…] Sulfapyridine and penicillin gave no protection.”.

I suspect my misunderstanding really stems from an episode of NCIS. Embarrassing.

EDIT: I hope they’re talking about the combo!

 

[Astronuc]

Well, it's happened again, but in California. The article states 'recently', but it is not clear how recently; there was a case in 2019.

Other sources indicate a recent case and infer 2025.

A resident of South Lake Tahoe has tested positive for the plague, El Dorado County health officials confirmed Tuesday, marking the first human case in the county since 2020.

https://ktla.com/news/california/california-reports-plague-case-should-residents-be-worry/

El Dorado County government reported on August 19, 2025 that.a resident tested positive for plague. Some rodents tested positive for plague.
https://www.eldoradocounty.ca.gov/C...s-Releases/Resident-Tests-Positive-for-Plague

Additional information from the LA Times.

The most recent case before this one was reported in El Dorado County in 2020 and also was believed to have been transmitted in the same area, officials said. Two plague cases were reported in California in 2015, suspected to have been caused by bites from an infected flea or rodent in Yosemite National Park.

The plague is caused by the bacterium Yersinia pestis and primarily affects small animals or rodents in the United States, Swartzberg said.

There are three types of the plague:

• bubonic plague, with the trademark swollen lymph nodes;
• septicemic plague, when the infection spreads throughout the body;
• pneumonic plague, which infects the lungs.

The plague was introduced to the U.S. in the early 20th century from rat-infested steamships arriving in California from Asia, with the first case identified in the San Francisco area, Swartzberg said.

In the middle ages, the plague was carried by rodents, which were transported by ships along trade routes in the Mediterranean sea, and possibly along land trade routes.

Woodland creatures that could carry the disease and should be avoided include chipmunks, wood rats, mice and marmots.

In California, the plague may be carried by rodents in the foothills, plateaus, mountains and along the coast. South Lake Tahoe is in the mountain on the east side of the state on the border with the state of Nevada.

There is the potential for exposure throughout Los Angeles County, but areas where the risk is highest are the rural recreational and wilderness areas of the Angeles National Forest and San Gabriel Mountains, county officials said.

Treatment for plague.

Streptomycin is the antibiotic of choice for pneumonic and septicaemic plague. However, it has potentially severe adverse effects (ototoxicity and nephrotoxicity), and needs to be administered parenterally (20 intramuscular injections, commonly over a 10-day course). Fluoroquinolones have been proposed as an alternative because they have a good safety profile, can be given orally and are used in the treatment of other lower respiratory tract infections.

https://www.ncbi.nlm.nih.gov/books/NBK571125/

Doxycycline is widely accepted as a monotherapy for bubonic plague; however, in some settings, there is concern that a single bacteriostatic drug might not be sufficient, and the preferred option might be treatment with an aminoglycoside or combination treatment.

Apparently, Gentamicin and fluoroquinolones are typically first‐line treatments in the United States. Duration of treatment is 10 to 14 days, or until 2 days after fever subsides. Oral therapy may be substituted once the patient improves.
https://www.cdc.gov/plague/resources/recommended-antibiotics-for-plague-web-site-rev-jan2018-p.pdf

The document also states that streptomycin is not widely available in the US, and gentamicin is not approved by the FDA.