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Plague victim: 7-year-old remains in hospital

A Pagosa Springs girl is recovering from bubonic plague in a Denver area hospital, and her family is now speaking out about the situation.

Sierra Jane Downing, 7, contracted the illness while recreating with her family at Cimarrona Campground, in the vicinity of Williams Reservoir, and was airlifted to Denver days later. This is the first human case of bubonic plague in Colorado since 2006.

In an interview, Sierra’s mother, Darcy Downing, relayed the course of events.

The Downing family took a Sunday, Aug. 19, day trip to Cimarrona Campground to take a break from preparing to move to a new house. While in the area, Darcy said the family had made its way to a nearby field to play a game and, on the way, Sierra had seen a half-eaten squirrel that she asked to bury because it upset her.

Sierra was told to leave the squirrel alone, but, while the other family members were focused elsewhere, the animal lover in Sierra won out, and she went to bury the squirrel, in the process dropping her sweatshirt nearby and stirring up the dirt around the dead animal.

When parents Darcy and Sean were ready to leave, they told Sierra to come and to grab her sweatshirt and tie it around her waist.

It wasn’t until the next Thursday that Sierra began complaining of being tired and nauseated, and Friday morning before she began showing flu symptoms.

As the day progressed, Sierra’s symptoms worsened and, at about 9 p.m. that evening, she threw up and collapsed in the bathroom with no energy.

Dad Sean picked her up and sat with her, at which point Sierra began to have a seizure that Darcy said stopped Sierra’s breathing.

“It was terrible. He thought she had died,” Darcy said.

While Sean ushered Sierra and her two sisters, Brianna and Tiarra, to the family vehicle, the sisters called 911, taking the landline phone with them in the family’s vehicle.

While Sean and her sisters took Sierra to the hospital, an Archuleta County Sheriff’s Deputy was dispatched to pick Darcy up from the home the family was preparing to move to in Aspen Springs.

Upon arrival at Pagosa Springs Medical Center, Sierra had a temperature of 107 degrees. Hospital staff used ice and wet towels to lower her core temperature while the lead doctor called larger hospitals to which the patient could be transported.

“The ER was amazing,” Darcy said. “Everyone involved did their job to perfection.”

After calling several hospitals and considering a feveral seizure as a diagnosis, Rocky Mountain Children’s Hospital at Presbyterian/St. Luke’s agreed to take Sierra and, when her temperature was low enough, she was airlifted to Denver, the plane landing at 5:30 a.m.

While on the flight, nurses noticed bites around Sierra’s torso, Darcy said.

After arriving at the hospital, doctors (including Dr. Jennifer White) considered meningitis, performed a spinal tap that came back negative, and started introducing antibiotics.

But, those antibiotics caused Sierra to no longer be stabilized and have blood pressure issues, fever spikes, redness and bumps.

“It was like the bubonic was attacking her from the inside out,” Darcy said.

Next up, Dr. Snow (a name not lost on Darcy following treatment by Dr. White), questioned if the illness might be plague and contacted Dr. Wendi Drummond, a pediatric and adult infection disease specialist.

“These women saved her life, they really did,” Darcy said of the doctors.

At that point, Drummond began asking about animal encounters, with the squirrel encounter standing out to the doctor and the bites on Sierra’s torso determined to be flea bites.

As the pieces started to fall together, Sierra was still unconscious, with unstable blood pressure and swelling in her glands (another indicator of bubonic plague), and Drummond began introducing six antibiotics and other medicines aimed at treating the problem.

“We treat a fair number of children who present with septic shock, so we are accustomed to seeing very ill children. In this particular case, there were some very unusual features in her presentation and history which led me to suspect something more rare and serious,” said Drummond in a press release. Drummond then immediately notified the State Health Department.

Two days later, doctors found that the culture taken Saturday was growing, leading to the confirmation of bubonic plague.

“I’ll never forget the moment when the doctor came in and said, ‘Something’s growing,’” Darcy said, adding, “It was otherwordly.”

Then, as the family was still adjusting to the diagnosis and Sierra was stabilizing, Darcy began a prayer chain on Facebook, also posting updates about Sierra’s health (without mentioning the plague).

“We just got the whole universe praying,” Darcy said.

As of Monday, Sept. 3, Sierra was moved out of the Pediatric Intensive Care Unit and into the general unit on the pediatric floor, began physical therapy, took her first walk since entering the hospital, and enjoyed a book with Sean.

A Tuesday night Facebook update noted continued concern about Sierra Jane’s pancreas. The Downings and medical staff were slated to do a press conference in Denver Wednesday morning.

Sierra Jane is rounding out her antibiotic treatment for the illness and is no longer contagious, Darcy said. The family has also been in contact with San Juan Basin Health Department and the Centers for Disease Control to ensure no one else contracts bubonic plague.

Joe Fowler, an RN specializing in disease control with SJBHD, said the family’s pets were given clean bills of health by a veterinarian and did not contract the illness.

Beyond the prayers and medicines, Darcy said cards and gifts from friends have worked to help Sierra Jane.

Additionally, Darcy said the community has been amazing in helping to arrange the family’s move, which was scheduled to take place last week. Friends and family gathered together, moving items and hiring a moving company to facilitate the rest of the move.

“We just sit and weep in our room, feeling so loved and so touched by the community,” Darcy said. “It blows my mind.”

Reaching out

Sierra may not be out of the hospital yet, but the family, including Girl Scout leader Darcy, is already looking for ways to educate others about animal safety and the illness.

Darcy said she has already met with representatives of the Center for Disease Control and Girl Scouts about putting together a “teachlet” and incorporating learning about bacteria and animals into troop activities.

“We’re trying to be proactive,” Darcy said.

Contributions

Contributions toward Sierra Jane’s medical expenses can be made to an account at Wells Fargo. The account is Norah Downing for Sierra Jane Downing.

Bubonic plague

Drummond explained that plague is caused by a bacteria called Yersinia pestis. Rodents, such as rats and squirrels, can carry the disease, and it is spread to humans by bites from infected fleas or handling of infected animals; or, in the case of pneumonic plague, through inhaling infectious droplets from an infected person who is coughing. Bubonic plague is different from pneumonic plague, which is an infection of the lungs causing severe pneumonia. Bubonic plague is characterized by fever, chills and the presence of very swollen and painful lymph nodes. Patients may have fever, vomiting and other non-specific symptoms and may progress rapidly to shock and multi-organ failure.

Fowler said bubonic plague naturally survives in nature, with the local environment “ideal” for the bacteria, adding that no conclusions about the prevalence of the bacteria could be made from a single human case.

In the mid 2000s, when cases of bubonic were more prevalent in La Plata County, Fowler said there were die-offs of rodent populations that officials were able to track. Fowler noted that, indeed, where a rodent population is thriving, the chance of bubonic is lessened.

“What I would like people to understand is that it is part of our environment,” Fowler said, and the risk of contracting the illness can be drastically minimized by taking the following precautions.

Precautions

The following precautions were provided by SJBHD.

• Avoid contact with all sick and dead rodents and rabbits. Look for the presence of blow flies or dead animal smell as evidence of animal die-offs. Prairie dog colonies that suddenly are not active may also be due to plague activity in the area. Report such die-offs to San Juan Basin Health Department at 335-2052

• While hiking, treat pants, socks, shoe tops, arms and legs with insect repellents.

• Do not ever touch a dead wild animal. Do not approach or pick up wildlife. If you see an animal that appears to be sick in southwestern Colorado, call Colorado Parks and Wildlife at 247-0855.

• Keep your pets from roaming and hunting and talk to your veterinarian about using an appropriate flea control product.

• Sick pets should be examined promptly by a veterinarian.

• If you hunt or trap rabbits or carnivorous wild animals, such as coyotes and bobcats, protect your hands and face while skinning or handling these animals. Fresh pelts may be treated with flea powder.

• Bites from wild carnivores and from cats and dogs have caused human plague. Such animals may be infected, carry the bacteria in their mouths or may transport infective fleas.

• Do not feed or entice any rodent or rabbit species into your yard, back porch or patio.

• Eliminate rodent habitat, such as piles of lumber, broken cement, trash and weeds around your home or recreational cabin.

• Make sure that houses and outbuildings are as rodent-proof as possible. Keep foundations in good repair and eliminate overhanging trees from roof and windows.

• When outdoors, minimize exposure in rodent-infested areas. Do not catch, play with, or attempt to hand feed wild rodents.

• The incubation period is two to six days. Consult a physician if sudden unexplained illness occurs within that period.

For more information on bubonic plague, visit www.cdc.gov/plague.

randi@pagosasun.com

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