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August 6, 1997

Fatal Human Plague—Arizona and Colorado, 1996

JAMA. 1997;278(5):380. doi:10.1001/jama.1997.03550050040014

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IN 1996, five cases of human plague, of which two were fatal, were reported in the United States; both decedents had septicemic plague that was not diagnosed until after they died. This report summarizes the investigation of the two fatal cases and underscores the need for health-care providers in areas with endemic plague to maintain a high level of awareness about the risk for plague in their patients.

Patient 1  On August 2, 1996, an 18-year-old resident of Flagstaff, Arizona, was taken to a local outpatient clinic because of a 2-day history of fever, pain in his left groin, and diarrhea. On examination, he was afebrile, had a pulse rate of 126 beats per minute, respiration rate of 20 breaths per minute, and blood pressure of 130/81mm Hg. Left groin swelling and tenderness were noted. A groin muscle strain was diagnosed and attributed to a fall 2 days earlier.

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