The Plague/ The Black Death Flashcards

1
Q

Plague - Symptoms

A
  • incubation of 2-6 days, death in ~2-4 days
  • 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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2
Q

Plague Pandemic - The Plague of Justinian

A
  • the first pandemic
  • named after the Eastern Roman Emperor Justinian
  • started in the 6th century (541-542 AD)
  • caused by Yersinia pestis
  • spread to the Mediterranian, Italy and throughout Europe
  • ~50% of the population is estimated to have died
  • continued in cycles for another 200 years until about 750 AD then disappears for ~800 years
  • estimated to have killed 100 million people
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3
Q

Yersinia - bacteria type and shape

A
  • gram negative, rod shaped
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4
Q

Yersinia - Name three species that are pathogenic for humans

A

Y. enterocolitica
Y. pseudotuberculosis
Y. pestis

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5
Q

Y. enterocolitica

A

causes “yersiniosis” – a rare cause of diarrhea and abdominal pain

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6
Q

Y. pseudotuberculosis

A

primarily an animal pathogen that can cause tuberculosis-like symptoms in animals, enteritis in humans

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7
Q

Y. pestis

A
  • cause of the plague
  • discovered by Alexandre Yersin in 1894
  • pestis –> pestilence (contagious or infectious epidemic disease)
  • an extraordinarily virulent pathogen
  • may causes death in 2-4 days by sepsis and/or overwhelming pneumonia with respiratory failure
  • NOT an efficient colonizer of humans
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8
Q

What nursery rhyme is based on the Black death?

A

Ring-a-round-a-rosie

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9
Q

Plague Pandemics - The Black Death

A
  • the second pandemic
  • a medieval pandemic caused by Yersinia pestis
  • originated in Asia and reached Europe in the late 1340s
  • reduced the global population from ~450 million to ~350 million
  • killed ~25 million Europeans (1/3 of the total population)
  • European social order, family structure, agriculture, military and feudal system were destroyed
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10
Q

When did the Black death occur?

A

1348, a time when there was no real treatment and the feat turned to panic

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11
Q

What did people believe was the cause of the pandemic?

A
  • God’s anger or Satan’s influence
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12
Q

What is the Feudal System

A
  • Political and Social structure prevalent in Europe
  • little opportunity for advancement
  • a few people had everything, most had little
  • Plague created vacant towns and farms, positions of authority need to be filled
  • demand for physicians, clergy, gravediggers
  • provided new opportunities for the peasants
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13
Q

Did Y. pestis really cause the Black Death? What is the evidence?

A

Re-sequenced the bacteria of teeth of the people that have died in that time (from cemetery)
It did cause it
The one of Justinian was a different strain, eventually bacteria killed all of its hosts and it ended up dying off

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14
Q

Where do Yersinia pestis live and how are they transmitted?

A
  • organisms live in rodents and are transmitted by fleas
  • a “zoonotic” pathogen
  • Y. pestis causes “blocking” in the flea
  • biofilm formation in the proventriculus
  • “starving fleas”
  • causes regurgitation of organisms
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15
Q

Where do Yersinia pestis live and how are they transmitted?

A
  • organisms live in rodents and are transmitted by fleas
  • a “zoonotic” pathogen
  • Y. pestis causes “blocking” in the flea
  • biofilm formation in the proventriculus organ
  • “starving fleas” because fleas cannot take the blood meal to its stomach
  • causes regurgitation of organisms as they continue to bit other organisms
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16
Q

Virulence Factors of Yersinia pestis

A
  • Y. pestis has a remarkable ability to overcome immune defense mechanisms resulting in massive growth in vivo

Major virulence factors include:

  • LPS (septicemia)
  • Phospholipase (survival in the flea)
  • Plasminogen activator –> clot buster (dissemination)
  • Yersiniabactin – iron binding siderophore
  • Type III secretion (typical for Gram negative intracellular pathogens)
17
Q

Virulence Factors of Yersinia pestis

A
  • Y. pestis has a remarkable ability to overcome immune defense mechanisms resulting in massive growth in vivo

Major virulence factors include:

  • LPS (septicemia)
  • Phospholipase (important for survival in the flea)
  • Plasminogen activator –> clot buster (dissemination; allows bacteria to spread)
  • Yersiniabactin – iron binding siderophore
  • Type III secretion (typical for Gram negative intracellular pathogens)
18
Q

Evolution of Y. pestis

A
  • Y. pestis evolved from Y. pseudotuberculosis
  • Y. pestis acquired new virulence plasmids
  • all pathogenic Yersinia contain pYV which encodes the type III secretion system
  • primary an intestinal pathogen of animals and is found widely in the environment
  • can infect the flea and is hypervirulent in humans, but does not survive well in the animal intestine
19
Q

What are the three major forms of the Plague disease?

A
  • bubonic plague
  • septicemic plague
  • pneumonic plague
20
Q

Bubonic plague

A
  • most common form, transmitted by flea bites
  • painfully swollen lymph nodes (“buboes”) in groin, armpits and neck
  • can develop into both septicemic and pneumonic plague
  • 40-60% mortality if untreated
21
Q

Septicemic Plague

A
  • presence of Y. pestis is systemic (in the blood)
  • an overwhelming and progressive bacteremia
  • fleas bites can now pick up Y. pestis to transmit to a new host
  • patients experience gangrene and disseminated intravascular coagulation (LPS mediated)
  • 50-90% mortality if untreated
22
Q

Pneumonic Plaque

A
  • most dangerous
  • transmission via aerosols directly into the lung, or spread to lungs from septicemic plague
  • short incubation
  • disease can pass directly from person-to-person through coughing (coughing up blood)
  • 95%-100% mortality if untreated, but treatment should be within first 24h of symptoms
23
Q

What is a pandemic?

A

An epidemic that becomes widespread over several regions, countries or continents.

24
Q

What are the four routes of transmission for the human disease?

A
  • Flea-bite (most common)
  • Inhalation from humans (pneumonic) or animals
  • Handling infected animals (skin contact, scratch, bite)
  • Ingesting infected meat
25
Q

Historically, what is transmission of the plague related to?

A
  • rat-borne urban epidemics
26
Q

What is transmission of the plaque now mostly associated with/

A

wild-life associated with sporadic outbreaks

27
Q

Diagnosis, Treatment and prevention of the Plague

A
  • rapid diagnosis and treatment is essential
  • culture and identification from bubo aspirate, sputum, blood (post-mortem) may take 4 days
  • isolation of pneumonic plague patients
  • insecticides to kill fleas, treat human cases with antibiotics, prophylaxis to exposed individuals
28
Q

Plague as a bioterrorism agent

A
  • The Centers for Disease Control and Prevention identify Plague as a “Category A” organism
  • can be easily disseminated or transmitted from person to person
  • result in high mortality rates and have the potential for major public health impact
  • might cause public panic and social disruption
  • Y. pestis is easy to grow (2 days)
29
Q

Known incidents

A
  • in 1347 the Mongol armies catapulted plague-ridden bodies over the city walls in Caffa, Ukraine
  • In WWII, Unit 731 of the Japanese Imperial Army infected fleas and released them in China
  • Larry Wayne Harris, an American “microbiologist”, with suspect motives obtained Y. pestis through the mail (American Type Culture Collection)
30
Q

WHO worst - case scenario

A

Aerosol release of 50 kg Y. pestis over city of 5 million people (150,000 infected; 36,000 deaths)