(B) Lecture 12: The Black Death Flashcards

1
Q

Yersinia

A
  • Gram NEGATIVE
  • rod shaped bacterium

3 species are pathogenic for humans:
- Y. enterocolitica: causes diarrhea + ab pain
- Y. pseudotuberculosis: cause TB-like symptoms
- Y. pestis: cause of plague

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2
Q

What bacterium is responsible for Plague?

A

Yersinia pestis

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3
Q

Yersinia pestis

A
  • pestis = pestilence (contagious)
  • may cause death in 2-4 days by sepsis and/or overwhelming pneumonia
  • NOT an effective colonizer of humans = causes death or immune system kills it
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4
Q

Plague

A
  • incubation of 3-7 days
  • patients experience sudden onset of fever, chills, headaches, muscle pain, weakness
  • painful swelling (BUBOES) of lymph nodes in armpits, legs, neck or groin
  • high fever, derilium and mental deterioration, vomiting of lungs
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5
Q

Plague pandemics

A
  • Plague of Justinian (first pandemic)
  • The “Black Death” (second pandemic)
  • Mid-19th century (third pandemic)
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6
Q

Plague of Justinian

A
  • first epidemic
  • named after Roman Emperor
  • started in 6th century
  • caused by Yersinia pestis
  • spread to Mediterranean, Italy and throughout Europe
  • approx. 50% of population died
  • continued in CYCLES for another 200 years
  • estimated to have killed 100M ppl
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7
Q

The “Black Death”

A
  • caused by Yersinia pestis
  • originated in Asia and reached Europe
  • reduced global population by 100M
  • no real treatment - fear turned to panic
  • many ppl believed this was due to God’s anger or Satan = persecution of minorities + witches
  • European social order, family structure + feudal system were destroyed
  • Plague Doctor
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8
Q

Plague Doctor

A
  • beak/plague mask would be filled w/ flowers to “help w/ stench” – actually protected them from microbes
  • random ppl would dress up as physicians to make money
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9
Q

Feudal System

A
  • political and social structure prevalent in Europe
  • peasants -> knights -> nobles -> king
  • little opportunity for advancement
  • a few ppl had everything, most had little
  • plague infected everyone = made holes in feudal system
  • plague created vacant towns/farms + positions of authority needed to be filled
  • provided new opportunities for peasants (demand for physicians, clergy)
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10
Q

How did they know that Y. pestis caused the Black Death?

A

Victims were buried and recorded well

Today, they use teeth + genomic sequencing technology to find Y. pestis

Found that DIFFERENT strains caused the Plague of Justinian and Black Death

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11
Q

The third pandemic

A
  • Mid-19th century
  • spread through infected RATS that exchanged fleas w/ local wildlifr
  • started in China + spread to all continents
  • go to southwestern US
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12
Q

Pathogenesis of Y. pestis

A
  • organisms live in RODENTS + are transmitted by fleas
  • a ZOONOTIC pathogen
  • causes “blocking” in flea = STARVING fleas (fleas can bite but can’t get bloodmeal = flea is alwas hungry and biting different hosts) - mechanism of transmission
  • very LOW infective dose
  • Y. pestis initially survives and grows in innate immune cells –> replicates in lymphoid organs
  • lymph nodes –> swelling –> buboes
  • Kills phagocytes and continues to grow extracellularly
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13
Q

Virulence factors of Y. pestis

A
  • remarkable ability to overcome immune defenses = large growth in vivo

Major virulence factors
- Type III secretion (in gram NEG INTRACELLULAR bacteria)
- Phospholipase (survival in flea)
- Plasminogen activator = clot buster (dissemination: clot-busting allows transmission)
- Yersiniabactin – iron binding siderophore (allows pathogens to get iron to grow)
- LPS structure is ‘mutated’ =innate immune system does not recognize it immediately (only in gram NEG)

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14
Q

Type III Secretions

A
  • found only in gram NEG pathogens (usually INTRACELLULAR)
  • molecular syringe that crosses 3 membranes
  • secrete virulence factors (effectors) directly into host cells across host cell membrane
  • effectors ‘poisons’ host cell by targeting host cell signaling pathways

MOST gram neg bacteria that live in host cells have type III secretion systems

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15
Q

Evolution of Y. pestis

A
  • Y. pestis evolved from Y. pseudotuberculosis
  • Y. pestis acquired new virulence PLASMIDS
  • all pathogenic Y. pestis contain pYV which encodes type III secretions
  • Y. pestis can infect flea and is hypervirulent – survives well in animal intestine
  • Y. pestis LPS molecule is weakly recognized by innate immune system due to mutation in LipidA enzyme
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16
Q

Y. pseudotuberculosis

A

mainly an intestinal pathogen of animals
- found widely in environment

causes TB-like symptoms

17
Q

Major forms of plague

A
  • Bubonic plague
  • Septicemic plague
  • Pneumonic plague
18
Q

Bubonic plague

A
  • most COMMON form
  • transmitted by FLEA bites
  • painfully swollen lymph nodes (buboes) in groin, armpits and neck
  • can develop into septicemic and pneumonic plague
  • 40-60% mortality, if untreated
19
Q

Septicemic plague

A
  • presence of Y. pestis is systemic (in blood)
  • an overwhelming and progressive bacteremia (bacteria in blood)
  • fleas can pick up Y. pestis to transmit to a new host
  • patients experience gangrene and disseminated INTRAVASCULAR COAGULATION
  • 50-90% mortality if untreated (higher mortality than bubonic plague)
20
Q

Pneumonic Plague

A
  • MOST DANGEROUS
  • transmitted via aerosols directly into the lung, or spread to lungs from septicemic plague
  • short incubation
  • disease can pass directly from person-to-person thru coughing (NO VECTOR)
  • 95-100% mortality if untreated, but treatment must be within first 24h of symptoms
21
Q

Transmission of plague

A

4 routes for human disease:
- FLEA-BITE (MOST COMMON)
- inhalation from humans (pneumonic) or animals
- handling infected animals - skin contact, scratch, bite
- ingesting infected meat

Historically rat-borne
- now mostly wildlife associated plague

22
Q

Diagnosis, Treatment and Prevention of Plague

A
  • rapid diagnosis + treatment is ESSENTIAL
  • in endemic regions, there are stains + rapid antigen tests
  • pneumonic patients should be isolated
  • insecticides to kill fleas
  • appropriate antibiotics including prophylaxis to exposed individuals (treat BEFORE sickness if you think they’re exposed)
23
Q

Plague as a bioterrorism agent

A

CDC identifies Plague as a “Category A” organism
- can be easily spread + transmitted from person to person
- high mortality rates
- might cause public panic + social disruption

In 1347, Mongol armies catapulted plague-ridden bodies over the city walls

In WWII, Japanese Army infected fleas and released them in China

24
Q

Plague currently around the world

A

Madagacar is a hotspot for plague
- epidemic

No plague in Canada, Australia or Antarctica