10/02/2005

The Black Death and AIDS

More from Daily Kos: Night of the Living Dead: Blood Warriors:

The most likely culprit for the Black Death was several enemy divisions working together in the theatre of blood. The progenitor of the Bubonic Plague: A bacteria called Yersinia pestis carried by infected fleas clinging to rats formed up the first wave. But there were other actors that followed closely behind in this chilling drama. Yersinia would engage the immune system, puffing up the lymph nodes with buboes, weakening the entire defense. Then anthrax, smallpox, typhus, tuberculosis, and maybe even ebola, flooded in opportunistically, free to evolve into more virulent strains. Half a dozen such microbes operating in synergistic concert best explain the geographical patterns and symptoms of the Black Death pandemic. But in 1347 the first crude microscope is hundreds of years in the future, the disease theory even more remote, the first antibiotics won't be formulated for more than half a millennia: Those early doctors didn't stand a chance of creating an effective treatment.



This is no Club kid. This is the reality of Acral Necrosis in the lips, nose, hands and fingers, of a victim recovering from Bubonic Plague. As bad as it looks in the photo, the patient's entire body surface was affected prior to a regimen of IV antibiotics

Between a quarter and half the population was wiped out in just a couple of years with large European cities especially hard hit. This had profound effects on the structure of feudal society which echoes into our own era. Some argue that the middle class rose as a direct result of common labor suddenly commanding a premium in the aftermath. Cultural icons reach well into our high-tech antiseptic world today: "Ring around the rosy", the robed spectre of the Grim Reaper, the Goth subculture with pasty faces and painted on bruises, and Monty Python's "Bring out your Dead", being just a few notable examples.

But this tale is not the modern costumed version of a fake fright night; children adorned with made up faces highlighted in dark eye shadow with blackened glossy fingernails. Oh no, that is all just a game my friends. This spectacle I'm reviewing was all too genuine.

This was a real Horror Show premiering in 1347 AD written by Mother Nature gone mad and coming soon to a town near you. At the crescendo of the Black Death, entire communites were abandoned to the sick and dying; some burned to the ground intentionally or by accident. Leaving animated quasi-zombies oozing dark blood through cracked, blistered skin, stumbling hopelessly through the ruins and streets in mobs dying en masse..

The healthy fled in panic before them, lest they too be infected. Among the throngs of terrified refugees running for their lives away from the rotten city centers are many in the early throes of infection carrying their deadly cargo to the farthest reaches of the Realm. No: This is not a costume ball marking the Fall Festival in which the attendees will be back to normal by the morrow: This was the Night of the Living Dead come jumping off the silver screen in full stereo surround sound accompanied by the stench of decaying bodies playing every night, everyday, all year long, offered to the public at no charge ...

As far as survival at the time itself, if you contracted the plague your only chance was your own, homegrown immune system. Strangely some folks seemed to sail right through it with relatively minor symptoms. Even stranger, some folks never developed any symptoms at all despite being right in the middle of the greatest outbreaks. This immunity and resistance paid no heed to title or deeds. But it did seem to follow hereditary lines..

Enter the blood warriors, one of our most effective armored divisions in the blood wars: The Leukocytes, white blood cells. Trigger happy killers they may be one and all, but these mercenaries work for us. They strike first and never ask questions later. So naturally their enemies have learned over the eons how to camouflage themselves and slip by the liquidating sentries unnoticed until they're ready to act. The killer cells in turn have to be ever more discriminating, yet ever more vicious. If the killer cells are too few or too late recognizing an attack, they lose and you die. If they're too overzealous and start firing at anything that moves, they'll eat you alive from the inside out, and you die. It's quite a precarious balancing act.

If, for whatever reason, these nanokillers get healthy tissue in their cross hairs, there is no talking them out of it, short of drugging them into complacency. They will tear into that tissue with the same gusto they use on the most deadly bacteria. The affected area activates adult stem cell populations in an attempt to keep healing ahead of the carnage. Swelling develops, scars form on scars, function is lost, all of which fools even more over zealous killer cells into attacking. The region grows in size usually becoming a source of chronic pain, eventual infection, and sometime death. Arthritis, Irritable bowel syndrome, type 1 diabetes, multiple sclerosis, lupus, and many others, are all examples of such autoimmune conditions.

It's bad enough when killer cells malfunction and go on a rampage though healthy tissue. But when the bone marrow develops a malignancy, a cancer, the white blood cells produced are like a giant, mutant, retarded form of an already implacable enforcer. Such conditions arise from all kinds of leukemia. Carl Sagan succumbed to complications from myelodysplasia, a similar condition.

OTOH, if these killer cells become diminished in either effectiveness or quantity, any number of hundreds of common microbes we carry around all the time can take us out. Infestation from staph, influenza, or other bugs left untreated can be fatal in a matter of days. Occasionally children are borne with a compromised immune system. And transplant patients take drugs designed specifically to weaken their immuno-response so as to mitigate rejection. Recent research suggests that a healthy immune system forms in part during childhood when youngsters are exposed to everyday dirt and grime.

Early in 1981, emergency rooms in New York City and San Francisco California began seeing an unusual spike in several rare diseases commonly associated with a weakened immune system. Young men, mostly gay or IV drug users, were developing rare forms of skin cancer and suffering from a puzzling pulmonary condition resembling pneumonia. Most of the lung infections turned out to stem from a common fungus which most folks can handle without even knowing it's present: Pneumocyctsis jiroveci. Despite aggressive antibiotics the infection never went completely away. Left untreated the condition progressed rapidly.

The hodgepodge of symptoms was eventually called "Acquired Immune Deficiency Syndrome" or AIDS. The actual agent is a virus called Human Immuno-virus or HIV. HIV appeared at first to be 100% fatal. Once contracted, sooner or later it will kill you with complications from opportunistic diseases. Once again religious opportunists moved in, much like their microbial counterparts, to take credit on behalf of their respective deities for the contagion. But this time there were microscopes, and labs, and men and women wearing white coats whose eyes and ears were greatly magnified by the tools of science.

Over the last twenty-years knowledge of AIDS has advanced considerably. The infection vector is now known to be fluid to blood contact. HIV reduces the number of one of the most important types of leukocytes called T-killer Cells. When the T-count declines drastically, otherwise fairly innocuous pathogens overwhelm the patient leading to eventual collapse of the immune system and deadly opportunistic infections such as the lung fungi. But there was something strange going on with some patients. They tested positive for the virus, but they never seemed to developed the symptoms and/or the disease progressed very slowly. Once again the resistance paid no attention to quality of treatment or method of infection: But as the cases accumulated some researchers began to suspect it ran in families.

The HIV pathogen is a clever bastard, especially considering it's amazingly simple even for a virus. The agent is part thief and part camo artist; it has to be to fool your cellular security. To get into the immune cells, it picks a lock on the surface called a Chemokine Receptor 5, or CCR-5. HIV cons the CCR-5 portal and slips past the molecular doorman. But a small number of people don't have that door, and thus there is no lock to pick, no doorman to trick! Normally this would be considered a defect. But in the presence of certain types of infectious disease, it became an advantage...

A defect, AKA a mutation, that prevents the formation of that receptor confers resistance to HIV. If you have this feature in only one copy of your chromosomes you have heightened resistance because you have fewer receptors. Two copies and you're (virtually) immune to HIV. Thing is, lacking a CCR-5 receptor could conceivably cause the individual so affected problems unrelated to AIDS. And yet the mutation is present in fairly high frequencies among some hereditary groups. If you're a northern European, there's a roughly thirteen percent chance you have at least one copy and about a two percent chance you have both. If you're a full blooded Swede, Brit, or German, if you can reliably trace that ancestry back for a dozen generations, the odds are significantly higher still.

Geneticists began looking into this mutation, tracking it's spread through extant populations, establishing points of origin and time frames. Surprise, surprise, it turned out to stem from northwestern Europe about 700 years ago! Right around the time that bubonic plague, small pox, tuberculosis, and anthrax were ganging up on folks and killing them by the hundreds of millions! Those who survived the onslaught were either lucky, or resistant. This rare, mildly disadvantageous trait was suddenly selected for aggressively. And for century after century, that same trait conferred resistance to other diseases, which may have aided those groups in everything from warfare to foreign conquest to business: If your competition is struck with an epidemic (One perhaps you yourself carry to them) that you are highly resistant to, you have a much better chance of winning the war be it economic or traditional.

A textbook example of evolution, "A change in the frequency of alleles within a population over time". It also turns out this Chemokine process is intimately bound up in other pathologies. And studies of the immune system centering on the role of T-cells has provided insight into everything from cancer to autoimmune disease we might otherwise never have had. The future applications could plausibly be monumental. Serendipity, the hallmark of science.

HIV cannot be cured for now, not yet. But for many it's no longer an immediate death sentence. Aggressive new drugs and lifestyle changes can greatly lengthen the life of an AIDS patient. In some cases the disease has even been stopped in its tracks. But the virus remains a fatal disease for most sooner or later, and the incidence of infection is climbing rapidly. It is estimated that 14,000 people are infected everyday with the greatest increase in Africa. Casualties of the blood wars.

Now, steeled by an epic blood feud fought by their forefathers inside our grandparents, a fortunate few may lead the way to curing so many of so much more. Thanks in great part to a long ago bloodwar fought 700 years in the past at the close of the Dark Ages, science may take the fight further than ever dreamed of during that terrible tragedy.

Daily Kos: Night of the Living Dead: Blood Warriors

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