Plague, caused by Yersinia pestis, is recognized as the most devastating acute infectious disease experienced by humankind.This notoriety is based upon the high rate of mortality, the rapid onset, and the appalling pathology associated with both the bubonic and pneumonic forms of the infection.Until recently, these extraordinary symptoms prompted investigators to describe the pestilence as a frontal assault upon the host that overwhelms innate mechanisms of defense, inevitably resulting in death caused by septic shock (10,19).It is now established, however, that the invading organisms inhibit the innate immune response, at least during the late stages of infection, thereby avoiding containment within granulomas (9).The first purpose of this review is to present two seemingly exclusive traditions that purport to define the process whereby yersiniae inhibit the generic inflammatory response.An attempt is then made to integrate these concepts.Of the 11 species of Yersinia (genus XI of the Enterobacteriaceae), those pathogenic to humans are Y. pestis and enteropathogenic Y. pseudotuberculosis and Y. enterocolitica.These three organisms share an approximately 70-kb plasmid, termed pCD in Y. pestis and pYV in the enteropathogenic species, that encodes at least one determinant required for the downregulation of inflammation (9, 75).Despite this common feature, the diseases caused by the two enteropathogenic yersiniae are chronic in nature and otherwise markedly distinct from plague (e.g., Y. pseudotuberculosis usually causes a modest mesenteric lymphadenitis in humans, and Y. enterocolitica typically promotes limited gastrointestinal disease).It is therefore remarkable that less than 20,000 years has elapsed since Y. pestis evolved from Y. pseudotuberculosis; divergence of the latter from Y. enterocolitica occurred about 1 million years earlier (1).The close relationship between Y. pestis and Y. pseudotuberculosis provides an excellent system for defining the hereditary events required for the evolution of acute disease.The known significant changes largely reflect lateral acquisition by Y. pestis of genes permitting infection by fleabite followed by dissemination through interstitial spaces and the lymphatics.In addition, the mutational loss by Y. pestis of functions required by enteropathogenic yersiniae for invasion via the small intestine may further contribute to the severity of plague (9, 75).Additional modifications of the Y. pestis genome that minimize inflammation as a mediator of innate immunity will also be addressed in this report.
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Robert R. Brubaker (2003) studied this question.
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