Expert: David Scott - 7/6/2011

Question
A 55 year old veterinarian was admitted to a hospital with a 2 day history of fever, chest pain, and cough. Gram-positive cocci were detected in his sputum, and he was treated for lobar pneaumonia with pencillin. The next day, another Gram stain of his sputum revealed gram-negative rods, and he was switched to ampicillin and gentamicin. A sputum culture showed biochemically inactive gram-negative rods identified as Pentoea (Enterobacter) agglomerans. After fluorescent-antibody staining and phage typing, Yersinia pestis was identified in the patient's sputum and blood, and chloramphenicol and tetracycline were administered. The patient died 3 days after admission to the hospital. Tetracycline was given to his 220 contacts (hospital pesonnel, family, and co-workers). What disease did the patient have?? Discuss what went wrong in the diagnosis and how his death might have been prevented. Why were the 220 other people treated?

Answer
The veterinarian caught the plague from fleas while working with animals.  Had he been dispensed a more modern antibiotic upon admission, he might have lived.  Why would penicillin be a first line treatment for lobar pneumonia?  The other 220 people were treated prophylactically.