A case of bubonic plague was recently discovered in Madagascar, an island in the Indian Ocean off the southeast coast of Africa. This is not the first case of bubonic plague discovered in recent years. Rather, it is the first case identified that is resistant to multiple antibiotics, including the ones commonly given to treat the plague.

Two years ago a 16-year-old boy on Madagascar was diagnosed with a drug-resistant plague bacterium. Three antibiotics were necessary to save his life. The isolated organism (Y. Pestis bacterium) was found to carry five antibiotic-resistant genes. The antibacterial drugs that this particular bacterium was resistant to were streptomycin, gentamicin, chloramphenicol, tetracycline and various sulfonamide compounds. It was found susceptible to trimethropim.

Although similar multiple drug- resistant gene transfers have been found in other disease-causing bacteria, never before have they been found in bubonic plague, a disease synonymous with debilitating epidemics and pandemics. Researchers don't know whether the Madagascar bacterium is rare or common, but they do know that it symbolizes the growing problem of antibiotic resistance in human pathogens.

Stuart Levy of Tufts University Medical School cautions, "We now know this agent exists, and have to be alert for it in other countries, where we know antibiotic resistance has emerged in so many other bacteria."

Drs. David Dennis and James Hughes of the CDC state that such incidents "provide another grim reminder that emerging infectious diseases and antimicrobial resistance in one location can pose serious problems for the entire world."