Course # DL-958: A Plague on U.S.

by Helen M. Sowers, M.A., CLS - Department of Biological Science - CSU East Bay (Retired)

Approved for 1.0 CE
Level of Difficulty: Basic

Case Study (1):

A middle aged couple was vacationing in New York City from their ranch in New Mexico. After several days of enjoying the luxury of their hotel and seeing the sights, they both began feeling ill. Their symptoms were similar, fever, fatigue, myalgia and one-sided inguinal swelling. Two days later, on Nov. 5, they went to an emergency room (ER) in a New York City hospital after consulting with their physician in New Mexico and the doctor at the hotel.

On admission the 55 year-old man appeared sickest with chills, diaphoresis (sweating), and lower extremity cyanosis. He had tender left inguinal adenopathy with overlying edema. His temperature was 104º F., blood pressure - 78/50, WBC count - 24,000/µL (normal: 4,300 - 10,800/µL), Platelet count - 72,000/µL (normal: 130,000 - 400,000/µL). A blood culture was taken and after 24 hours a gram stain showed bipolar gram negative rods.

The 47 year-old wife had tender right inguinal and femoral adenopathy with overlying erythema and induration. Her temperature was 102.2º F, blood pressure - 120/72, WBC count - 9,500/µL, platelet count - 189,000/µL. Aspiration of the inguinal lymph nodes did not yield any material.


1. What is the most probable organism recovered from the blood culture?

2. Where did the couple most likely become infected?

3. What is the usual route of infection for this disease?

4. The causative organism is on the list of possible bioterrorist agents. Why wasn't this episode considered to be a bioterrorist incident?


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