the black death Flashcards

1
Q

what’s the hidden meaning behind the song “ring around the rosy”?

A

the black death

ring around the rosy = lesions

pocket fully of posy = stench (tho it was transmitted by smell)

ashes, ashes = bodies were burned

we fall down = death

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2
Q

describe the yersinia bacterial genus (characteristics)

A

gram-

rod-shaped

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3
Q

what are the 3 pathogenic species of the yersinia genus? what do they cause?

A

y. entercolitica = yersinionsis, a rare cause of diarrhea and abdominal pain

y. pestis = plague

y. pseudotuberculosis = tuberculosis-like symptoms in animals AND enteritis in humans

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4
Q

who discovered yersinia pestis

A

discovered by Alexandre Yersin and Kitasato Shibasaburo in the late 1800s

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5
Q

did yersinia pestis really cause black death

A

if one’s infected, there would be bacteria in the blood which would get lodged in teeth (it’s hard & can protect
DNA)

sequence (nearly) the entire genome of Y. pestis using victim’s teeth –
this is the closest form of proof that Y. pestis caused the Black Death

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6
Q

how long is incubation of the plague? when may death occur from the plague?

A

3-7 days

2-4 days following incubation
— MAY occur

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7
Q

what are the symptoms of the plague?

A

patients experience sudden onset of fever, chills, headaches, muscle pain, weakness

painful swellings (buboes) of the lymph nodes in the armpits, legs, neck, or groin

high fever, delirium and mental deterioration, large blackish pustules that burst, vomiting of blood, bleeding in the lungs

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8
Q

name the 3 historical plague events in order?

A

plague of justinian

the black death

3rd plague pandemic

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9
Q

describe the 1st plague event

A

plague of justinian
- named after the Eastern Roman Emperor justinian

started in the 6th (541 AD) century

spread to Mediterranean, Italy, and throughout Europe

around 50% of the population is believed to have died
– estimated to have killed 100 million people

continued in cycles for another 200 years until about 750 AD then disappeared for approximately 800 years

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10
Q

describe the 2nd plague event

A

the black death
– a medieval pandemic

originated in Asia and reached Europe in the late 1340s

reduced global population from ~450 million to ~350 million
—- killed approximately 25 million Europeans (1/3 the total population)

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11
Q

what are plague doctors?

A

during the black death

normal people who assumed physician’s role

put flowers and herbs in their beak to protect themselves as they thought the cause was “bad air”
— didn’t actually protected them from the plague (but did protect from pneumonic)
— but their clothes that fully covered them did

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12
Q

how did the plague destroy the European feudal system during the black death?

A

plague killed the rich/powerful, creating vacancies for positions of
authority to be filled (e.g. physicians, clergy, gravediggers)

provided new opportunities for peasants

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13
Q

what was believed to have caused the black death?

A

God’s anger or Satan’s influence – led to the persecution of strangers, minorities, and witches

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14
Q

describe the 3rd plague event

A

started in China in 1850s → spread to ALL continents, where it remained active until 1959

> 12 million deaths in China & India alone

reached San Francisco in 1900 → infected rats on ships exchanged w/ fleas and local wildlife

currently endemic in Southwestern U.S. (carried by animals)

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15
Q

describe the infection phase of pathogenesis of yersinia pestis (in rodents and fleas)

A

a zoonotic pathogen
— organisms live in rodents and are transmitted by fleas

causes “blocking” in the flea, a biofilm formation in the proventriculus “starving fleas”, makes them regurgitate

rodents = reservoir

fleas = vectors

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16
Q

describe the growth phase of pathogenesis of yersinia pestis

A

very low infective dose (only around 10 cells)

it initially survies and grows in innate immune cells and replicates in lymphoid organs (spleen, bone marrow, lymph nodes, liver)
– can evade the mammalian innate immune response, allowing for infection prior to an immune response

lymph nodes swell, becoming buboes

y pestis kills phagocytes and continues to grow extracellularly
– they have a remarkable ability to overcome immune
defense mechanisms resulting in massive growth in vivo

at the terminal stage of the disease, the blood contains high concentrations of the bacterial cells
— essential for the transmission cycle because fleas take a blood meal

17
Q

what are the major virulence factors of yersinia pestis?

A

lipopolysaccharides (it’s gram-) which are “mutated” – septicemia (enter the bloodstream and spread)

phospholipase - important for survival in the flea

plasminogen activator (host protein) - breaks down clots and spreads bacteria

yersiniabactin - attracts iron, nutrients for bacteria

type III secretion system
—- typical for gram- intracellular pathogens
—- secretes virulence factors (“effectors”) directly into host cells across the cell membrane
—- effectors ‘poison’ host cell by targeting host cell signaling pathways

18
Q

what is nutritional immunity?

A

when body isolates or sequesters nutrients from infectious agents

e.g. iron

19
Q

describe the evolution of yersinia pestis

A

evolved from yersinia pseudotuberculosis

acquires new virulence plasmid that encodes the type III secretion system
—- yersinia is now pathogenic

acquires plasmid
—- yersinia pseudotuberculosis is now primarily an intestinal animal pathogen (widespread)

acquires another plasmid
—- yersinia pestis can infect the flea & is hypervirulent in humans; but does not survive well in animal intestine
—- now have pandemic yersinia

essentially: bacteria moving around, taking up plasmids (that encode things) and acquiring pathogenic traits

20
Q

what the 3 major forms of plague?

A

bubonic

septicemic

pneumonic

21
Q

describe the bubonic plague

A

most common form

transmitted by flea bites

symptoms: painfully swollen lymph nodes (“buboes”) in groin, armpits and
neck

can develop into both septicemic and pneumonic plague

22
Q

what’s the mortality of the bubonic plague?

A

40-60% mortality if untreated

23
Q

describe the septicemic plague

A

presence of Y. pestis is systemic (in the blood)

an overwhelming and
progressive bacteremia

fleas can now pick up Y. pestis
to transmit to a new host

symptoms: gangrene (decomposition of tissue)
and disseminated intravascular
coagulation (clotting disorder that’s LPS mediated)

can develop into pneumonic plague

24
Q

what’s the mortality of the septicemic plague?

A

50-90% mortality if untreated

25
Q

what’s the mortality of the pneumonic plague?

A

95-100% if untreated – treatment should be within first 24 hours

26
Q

describe the pneumonic plague

A

most dangerous

transmission via aerosols
directly into the lung, or spread to lungs from septicemic plague (allows person to person transmission - no flea necessary)

disease can pass directly from person to perso thru coughing up blood
– short incubation

27
Q

what are the 4 routes of transmission for human disease of yersinia pestis

A

fleabite (most common)

inhalation from humans (pneumonic) or animals

handling infected animals (e.g. skin contact, scratch, bite)

ingesting infected meat

historically, rat-borne urban
epidemics

now mostly wildlife associated plague with sporadic outbreaks

28
Q

describe diagnosis, treatment, and prevention for yersinia pestis

A

rapid diagnosis and treatment is essential
– culture and identification from bubo aspirate, sputum, blood (postmortem) may take 4 days

in endemic regions, there are stains and rapid antigen tests
– non-endemic regions may not recognize it as quickly

must isolation pneumonic plague patients

outbreaks
- insecticides are used to kill fleas, human cases treated with appropriate antibiotics including prophylaxis to exposed individuals (just in case)

29
Q

what level of bioterrorism was the plague categorized as?

A

category A (highest level)

bc it’s easily disseminated or transmitted from person-to-person

high mortality rates; potential for major public health impact

may cause panic

30
Q

what are known incidents where the plague was used as a bioterrorism agent?

A

used by Mongol armies in 1300s → catapulted infected bodies into city of Caffa, Ukraine

in WWII, Unit 731 (Japanese) released infected fleas into China

31
Q

in the world, where is the plague not found?

A

all continents except Australia

32
Q

why can’t the plague be eradicated in modern times?

A

since Y. pestis is widespread in wildlife rodent reservoirs

33
Q

describe the plague outbreak in madagascar

A

large outbreak starting in Aug 2017

approximately 2400 probable/confirmed cases, most were pneumonic

greater than 200 deaths