Plague among us

Bill Goldman is battling the next outbreak of the plague before it happens.

The plague is alive today, as evidenced by what happened in 2008, when biologist Eric York finds a dead mountain lion on the Grand Canyon’s southern rim. The lion has a bloody nose but no other signs of trauma. York performs an autopsy, which reveals nothing unusual.

Two days later, York develops a bad cough. He feels weak, achy, tired. His doctor tells him he has a flu-like illness and sends him home. Two days later, York dies.

The autopsy of York did reveal something. He was stricken with the plague, also known as the Black Death, the same disease that wiped out half of Europe during the fourteenth century. Public-health officials gave antibiotics to everyone who had come in contact with York.

No one else died. Disaster averted. But how did York’s doctor miss something as uniquely horrifying as the plague?

Turns out just about every doctor would’ve missed it, according to Goldman of UNC’s department of microbiology and immunology in the School of Medicine. Goldman and his colleagues are searching for a way to make the plague less like the Black Death and more like the flu, at least in terms of treatment of and recovery by patients.

“The first symptoms of the plague really are indistinguishable from the flu,” he says. But unlike the flu, the plague is already well on its way to shutting down the lungs by the time a patient begins to feel sick. It’s a sneaky, extremely contagious and fatal disease, three reasons why governments and researchers think the plague is a bioterrorism threat—a twenty-first-century weapon of mass destruction.

A bioterrorist attack

In medieval war, combatants catapulted infected bodies over city walls. Today, a bioterrorist attack would be stealthier and a lot more dangerous.

After the anthrax scare of 2001, the U.S. government pushed scientists to research various biological warfare threats, such as Yersinia pestis, the bacterium the causes the plague. “I hate to put it this way, but terrorists aren’t going to unload a bunch of rats or fleas into town,” Goldman says. They’ll culture the bacteria in massive amounts. “They’ll try to spread the disease by an aerosol,” he says.

Victims wouldn’t smell it or see it. They wouldn’t even feel a thing at first, but the disease would be on a rampage. Thousands of people would get sick but have no idea they had the plague until it was too late to save them.

The plague is such a silent killer because Yersinia pestis doesn’t trigger the same sort of quick immune response that most bacterial infections do. When a person contracts the plague, the bacteria multiply from a few microbes to a billion within 48 hours. But for some reason the lungs—typically very good at getting rid of undesirables—don’t respond.

How to make the plague more like the flu

In the case of Eric York, doctors had no way to distinguish his illness from the flu. Only when symptoms worsen—vomiting, difficulty breathing, coughing up blood—does the plague give itself away. “By then, when it’s recognizable as pneumonic plague, it’s too late to treat it,” Goldman says. The lungs are overrun with bacteria. The pulmonary system is all but shut down. The circulatory system can’t deliver antibiotics into the lungs. Patients suffocate to death. They just can’t breathe anymore.

“Here’s the question we wanted to answer,” Goldman says. “Is Y. pestis avoiding detection, or is it actually suppressing the immune responses of the lung?” The answer would give his team clues about how to make the plague less like the Black Death and more like the flu, at least in terms of patient prognosis.

Read more from the Endeavors article.

Published December 10, 2012.