THURSDAY, Sept. 6 (HealthDay News) -- When Sierra Jane Downing's fever shot up to 107 degrees and she suffered a seizure, her parents knew their 7-year-old daughter had more than the flu.

Thanks to a persistent doctor, the little girl is recovering in a Denver hospital from a case of bubonic plague, the first identified in Colorado in more than six years. It's thought she was bitten by infected insects -- probably fleas -- while trying to bury a dead squirrel on a family camping trip.

Hers is the fourth case of plague reported in the United States this year, the U.S. Centers for Disease Control and Prevention (CDC) said. "Over the last 10 years we have had an average of five cases a year," said CDC epidemiologist Kiersten Kugeler. "So this year is quite average."

However, plague -- the scourge of the Middle Ages -- is rare, so "people should not be panicky," she said.

Kugeler said many more cases occurred in the early 1980s, when some years saw 30 to 40 people with plague. The reduction in infections is most likely the result of better sanitation and climate, she said.

Of this year's infections, an Oregon man was the most severely affected and needed to have some fingers amputated, Kugeler said. He came down with plague after a bite from a family cat. It's suspected that a woman who had contact with the same cat also developed plague but that case has not been confirmed. The fourth plague patient was an elderly man in New Mexico.

Most people recover with antibiotic therapy, but early treatment is important, experts say. "The last plague fatality in the United States was in 2009, because it was not recognized early enough," Kugeler said.

Fleas infected with the bacterium Yersinia pestis are the usual source of plague, but infected animals, including rabbits, rodents and pets, can also transmit the disease.

The biggest barrier to treatment is that many doctors don't recognize the symptoms -- which include swollen lymph nodes -- as those of plague. In addition to a tender, swollen lymph node in her groin, Downing also had low blood pressure and a high heart rate, according to published reports.

The dimpled girl, hospitalized in late August, is expected to make a full recovery, but had it not been for a tenacious emergency room doctor near her home in Pagosa Springs, her story might not have had a happy ending. That doctor reportedly called several hospitals until he found one -- Rocky Mountain Hospital for Children -- that wanted to see her immediately. She was air-lifted to their facility.

Plague can occur anywhere in the western United States, Kugeler said. "Since plague was introduced to this country in 1900, it has not passed what we call the plague line," she noted. This longitudinal line roughly falls along the 100th meridian, which stretches north from Texas to North Dakota.

This probably has to do with environment, altitude, humidity and temperature -- the conditions necessary for these types of fleas to survive, she said.

The best way to guard against plague and other diseases transmitted by infected rodents is to remove places around the yard where rodents like to live, such as wood piles, Kugeler said.

Protecting pets from fleas and ticks is also essential, she pointed out.

Plague almost never spreads from person to person. The only time person-to-person transmission is possible is when the bacteria reaches the lungs, she said. Then the plague can spread to those in close contact with the patient for an extended time, and then only just before they die.

"The last case of person-to-person in this country was in the 1920s," Kugeler said.

In 14th-century Europe, the Black Death, as the plague was called, wiped out an estimated 35 percent of the population.

Nothing like that can happen here, experts say.

"Plague will never make a resurgence," said Dr. Marc Siegel, an associate professor of medicine at NYU Langone Medical Center in New York City. "We have public health measures in place that prevent that."

Treatment with antibiotics is effective, Siegel said. There is a need, however, for doctors to "think outside the box and recognize the possibility of plague," he said.

More information

For more information on plague, visit the U.S. National Library of Medicine.

FRIDAY, Sept. 7 (HealthDay News) -- U.S. and state health officials said Friday that they are investigating six overlapping, multistate outbreaks of human salmonella infections linked to turtles or their environments.

More than 160 illnesses have been reported in 30 states. Of those with salmonella infections, 64 percent are children aged 10 or younger, 27 percent are children aged 1 or younger, the U.S. Centers for Disease Control and Prevention said. Fifty-six percent are Hispanic.

"Many people don't know that turtles and other reptiles can carry harmful germs that can make people very sick. For this reason, turtles and other reptiles might not be the best pets for your family, especially if there are children 5 years old and younger or people with weakened immune systems living in your home," Casey Barton Behravesh, deputy branch chief in the CDC's Outbreak Response and Prevention Branch, said in a CDC news release.

Contact with reptiles such as turtles, snakes and lizards and with amphibians such as frogs and toads can be a source of human salmonella infections. Salmonella germs are contained in both reptile and amphibian droppings, and can easily contaminate their bodies and the water in their tanks or aquariums.

"Since 1975, it has been illegal in the United States to sell or distribute small turtles with shells that measure less than four inches in length. This ban, enforced by the [U.S. Food and Drug Administration], likely remains the most effective public health action to prevent salmonella infections associated with turtles," Dr. Tom Chiller, deputy branch chief of the Mycotic Diseases Branch at the CDC, said in the news release.

Despite this ban, small turtles continue to cause salmonella infections in people, especially among small children.

The CDC offers the following safety tips:

• Don't buy small turtles from street vendors, websites, pet stores or any other sources.
• Keep reptiles out of homes with young children or people with weakened immune systems. Do not keep reptiles in child care centers, nursery schools or other facilities with young children.
• Always wash your hands thoroughly with soap and warm water immediately after touching reptiles or anything in the area where they live and roam. Adults should always supervise hand washing for young children. If soap and water are not readily available, use hand sanitizer.

More information

The U.S. Centers for Disease Control and Prevention has more about reptiles, amphibians and salmonella.

THURSDAY, Sept. 6 (HealthDay News) -- Nearly one-third of doctors and nurses are not so thrilled with the idea that hospital patients should be encouraged to remind them to wash their hands before treating them, a new Swiss survey suggests.

The poll was conducted among medical workers at a health center in Geneva, and it also found that very few patients raise the issue with their doctors and nurses, despite rising global concerns about the threat of hospital infections.

"The results were very surprising," said survey author Dr. Yves Longtin, who conducted the research in 2009 while with the Infection Control Program and World Health Organization Collaborating Centre on Patient Safety at the University of Geneva Hospitals.

"Patients have been encouraged for many years to ask health care workers whether they cleaned their hands before caring for them," noted Longtin. "This movement has been implemented in numerous countries, including Canada, the U.S., the U.K. and Switzerland. There is no doubt that these campaigns were good-intentioned. However, health care workers' perceptions regarding these campaigns was little understood."

Longtin, who is currently an assistant professor and infectious disease microbiologist in the department of microbiology and infectious diseases at Laval University and Centre Hospitalier Universitaire de Quebec in Quebec City, Canada, reports the findings in a research letter published online Sept. 3 in the Archives of Internal Medicine.

In recent years, a rise in the rate of in-hospital antibiotic-resistant infections in the United States and abroad has focused public attention on hospital hygiene. The research team pointed out that good hand hygiene among health care workers is widely thought to be the number one way to curtail such infection risk.

To explore how the patient-caregiver relationship turns on this issue, the team randomly distributed a written survey to 700 nurses and doctors at the University of Geneva Hospitals. About 40 percent (277) responded, with 44 percent of those responses coming from doctors, and 56 percent from nurses.

The authors noted that about two-thirds of those who responded had more than a decade of experience under their belt, and that the hospital had a long history of promoting hand hygiene among its staff.

However, the hospital did not have a specific policy or program in place to promote patient participation on that front, and Longtin's team found that only 3 percent of the health care workers polled said they had been asked about hand hygiene by a patient in the month leading up to the survey.

Nearly three-quarters of the respondents did say that, generally speaking, more patient involvement might be helpful in reducing the rate of hospital infections.

However, 29 percent did not specifically support the notion that patients remind them to wash their hands, with 27 percent suggesting that it is not the role of a patient to do so, the investigators found.

Why the pushback? About one-quarter said that patient inquiries regarding hand hygiene would take up too much of their time, while 17 percent and 27 percent, respectively, said that such queries would be either upsetting or humiliating.

Between 43 percent and 44 percent of those polled added that they'd feel guilty and/or ashamed to be found out or forced to admit to patients that they had forgotten to wash their hands. About one-quarter said that such an admission would make them appear inept at their jobs, and 18 percent feared legal ramifications.

The poll suggested that such concerns may have implications for hospitals considering new hand hygiene policies, as nearly four in 10 (37 percent) said they would not agree to wear a badge that would specifically solicit patient inquiries on the issue.

"Health care workers have feelings, too, and patients have to be receptive to them," Longtin noted. "[This] shows that the implementation of a real safety climate will require some change in health care workers' mentalities in addition to convincing patients that they have a role to play in their care."

Dr. Philip Tierno, a clinical professor of microbiology and pathology in the department of pathology at NYU Langone Medical Center, sees the issue in black-and-white terms.

"The patient has every right to ask and know if health care workers wash their hands between patients," Tierno said. "And that is no matter who the person is, whether it is a nurse, a physician or a technician. Because hospital-acquired infections account for about 100,000 deaths in the U.S. alone per year, and 80 percent of all infectious disease is transmitted by either direct contact, such as coughing, talking, sneezing, or indirect contact, such as not washing your hands after touching a bed, a telephone, a doorknob in a patient's room," he explained.

"So there are many institutions in the U.S. that have initiated hand-washing programs," Tierno noted, "and I personally think it's foolish and myopic for any health care worker to be offended by a patient asking this sort of question. Patients have that right and they are justified in asking."

More information

For more on hand hygiene, visit the U.S. Centers for Disease Control and Prevention.

THURSDAY, Sept. 6 (HealthDay News) -- The intense preparation required for the law school admission test (LSAT) changes the structure of the brain, resulting in stronger connections between areas of the brain that play an important role in reasoning.

That's the finding of University of California, Berkeley, neuroscientists who used diffusion tensor imaging to analyze the brains of 24 college students or recent graduates before and after 100 hours of LSAT training over three months.

The findings suggest that training people in reasoning skills can reinforce brain circuits involved in thinking and reasoning and might even help increase a person's IQ scores, the researchers said.

"The fact that performance on the LSAT can be improved with practice is not new. People know that they can do better on the LSAT, which is why preparation courses exist," study leader Allyson Mackey, a graduate student in UC Berkeley's Helen Wills Neuroscience Institute, said in a university news release.

"What we were interested in is whether and how the brain changes as a result of LSAT preparation, which we think is, fundamentally, reasoning training. We wanted to show that the ability to reason is malleable in adults," she explained.

The U.S. National Institute of Neurological Disorders and Stroke funded the study, along with Blueprint Test Preparation, the release noted.

The study was published recently in the journal Frontiers in Neuroanatomy.

"A lot of people still believe that you are either smart or you are not, and sure, you can practice for a test, but you are not fundamentally changing your brain," senior author Silvia Bunge, an associate professor in the UC Berkeley department of psychology and the Helen Wills Neuroscience Institute, said in the news release.

"Our research provides a more positive message. How you perform on one of these tests is not necessarily predictive of your future success, it merely reflects your prior history of cognitive engagement, and potentially how prepared you are at this time to enter a graduate program or a law school, as opposed to how prepared you could ever be," Bunge noted.

Another expert, John Gabrieli, a professor of cognitive neuroscience at the Massachusetts Institute of Technology, agreed.

"I think this is an exciting discovery," Gabrieli, who was not involved in the study, said in the news release. "It shows, with rigorous analysis, that brain pathways important for thinking and reasoning remain plastic in adulthood, and that intensive, real-life educational experience that trains reasoning also alters the brain pathways that support reasoning ability," he explained.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about the brain.