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Chapter 19: Yersinia and Pasteurella

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An 18-year-old male resident of Arizona came to the emergency department (ED) complaining of fever, pain in his left groin, and diarrhea for the past 2 days. On examination, he was afebrile, had a pulse rate of 126 beats/min, a respiratory rate of 20 breaths/min, and a blood pressure of 130/80 mm Hg. Left groin swelling and tenderness were noted. A groin muscle strain was diagnosed, attributed to a fall 2 days earlier. He was treated with nonsteroidal anti-inflammatory drugs and released. The next day, the patient reported feeling weak, had difficulty breathing, and collapsed while taking a shower. He was transported to a hospital ED and pronounced dead shortly after arrival. Cultures of blood samples obtained in the ED were positive for Yersinia pestis. An epidemiologic investigation indicated that the patient most likely became infected as a result of bites by Y pestis–infected fleas while walking through a prairie dog colony (see Chapter 48). Which of the following statements about the pathogenesis of plague is correct?

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(A) Yersinia pestis produces a coagulase when incubated at 28°C.

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(B) There is no risk for pneumonia caused by person-to-person transmission of Yersinia pestis.

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(C) Yersinia pestis organisms multiply in polymorphonuclear cells.

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(D) After the bite of an infected flea, Yersinia pestis infection seldom, if ever, disseminates beyond the site of the flea bite and the regional lymph nodes.

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(E) Yersinia pestis is transmitted to animals (and humans) in flea feces excreted when the flea is feeding.

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An 18-year-old male resident of Arizona came to the emergency department (ED) complaining of fever, pain in his left groin, and diarrhea for the past 2 days. On examination, he was afebrile, had a pulse rate of 126 beats/min, a respiratory rate of 20 breaths/min, and a blood pressure of 130/80 mm Hg. Left groin swelling and tenderness were noted. A groin muscle strain was diagnosed, attributed to a fall 2 days earlier. He was treated with nonsteroidal anti-inflammatory drugs and released. The next day, the patient reported feeling weak, had difficulty breathing, and collapsed while taking a shower. He was transported to a hospital ED and pronounced dead shortly after arrival. Cultures of blood samples obtained in the ED were positive for Yersinia pestis. An epidemiologic investigation indicated that the patient most likely became infected as a result of bites by Y pestis–infected fleas while walking through a prairie dog colony (see Chapter 48).

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The drug of choice to treat the patient would have been

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(A) Ampicillin

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(B) Cefotaxime

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