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Plague, a zoonosis caused by Yersinia pestis, is endemic in Madagascar but knowledge on the epidemiological situation in the northern focus remains unclear. The aim of this study was to investigate the circulation of Y. pestis in terrestrial small mammals in north eastern Madagascar, where suspected plague outbreaks have been reported. Sampling of terrestrial small mammals and their fleas was carried out in 22 trapping sites within 9 localities of the two sectors (1 and 3) of Makira Natural Park (MNP) and surroundings, from 2020 to 2022. Yersinia pestis was investigated in terrestrial small mammal spleen samples and their fleas using bacteriological, serological and molecular methods. A total of 614 terrestrial small mammals composed of eight species and 1,754 individual fleas were collected following 4,880 trap-nights. The black rat (Rattus rattus) represented the majority (87.8%) of the small mammal species caught. Flea infestation rate was higher in sector 3 compared to sector 1. In sector 3, Xenopsylla brasiliensis, a plague vector, represented 66.4% of fleas identified. Further, one plague seropositive R. rattus individual, captured inside a house, and one Ctenocephalides felis specimen, collected on another R. rattus, was positive on PCR in this sector. Despite low detection rates, we confirmed the circulation of Y. pestis in our study area (one rat seropositive and one flea PCR positive) and highlight the risk of potential human transmission. Our results also suggest that R. rattus contributes to the maintenance and transmission of plague in MNP, as described for other areas in Madagascar. Further, these findings contribute to documentation of the known geographic distribution of the endemic plague vector S. fonquerniei and X. brasiliensis. The confirmation of the circulation of the Y. pestis through serological and molecular diagnostics in small mammals and fleas underscores the urgent need to assess awareness levels of risk factors and symptoms to monitor among local communities and health workers and ensure that trained rapid response teams are prepared to intervene promptly upon suspect case detection. The risk and epidemiology of plague circulation in remote rural areas of Madagascar remains insufficiently studied. Addressing this gap is crucial, as a more comprehensive understanding of the distribution and dynamics of the wild animal hosts, their vectors and host-vector interactions will enhance risk assessment and prevention for plague emergence and improve mitigation and early control of potential outbreaks.

Data on treatments for bubonic plague are limited. In this open-label, randomized, controlled trial in Madagascar, ciprofloxacin monotherapy was noninferior to a standard aminoglycoside–ciprofloxacin regimen.

The bacterial pathogen Yersinia pestis gave rise to devastating outbreaks throughout human history, and ancient DNA evidence has shown it afflicted human populations as far back as the Neolithic. Y. pestis genomes recovered from the Eurasian Late Neolithic/Early Bronze Age (LNBA) period have uncovered key evolutionary steps that led to its emergence from a Yersinia pseudotuberculosis-like progenitor; however, the number of reconstructed LNBA genomes are too few to explore its diversity during this critical period of development. Here, we present 17 Y. pestis genomes dating to 5,000 to 2,500 y BP from a wide geographic expanse across Eurasia. This increased dataset enabled us to explore correlations between temporal, geographical, and genetic distance. Our results suggest a nonflea-adapted and potentially extinct single lineage that persisted over millennia without significant parallel diversification, accompanied by rapid dispersal across continents throughout this period, a trend not observed in other pathogens for which ancient genomes are available. A stepwise pattern of gene loss provides further clues on its early evolution and potential adaptation. We also discover the presence of the flea-adapted form of Y. pestis in Bronze Age Iberia, previously only identified in in the Caucasus and the Volga regions, suggesting a much wider geographic spread of this form of Y. pestis. Together, these data reveal the dynamic nature of plague’s formative years in terms of its early evolution and ecology.

Yersinia pestis has caused at least three human plague pandemics. The second (Black Death, 14–17th centuries) and third (19–20th centuries) have been genetically characterised, but there is only a limited understanding of the first pandemic, the Plague of Justinian (6–8th centuries). To address this gap, we sequenced and analysed draft genomes of Y pestis obtained from two individuals who died in the first pandemic. Teeth were removed from two individuals (known as A120 and A76) from the early medieval Aschheim-Bajuwarenring cemetery (Aschheim, Bavaria, Germany). We isolated DNA from the teeth using a modified phenol-chloroform method. We screened DNA extracts for the presence of the Y pestis-specific pla gene on the pPCP1 plasmid using primers and standards from an established assay, enriched the DNA, and then sequenced it. We reconstructed draft genomes of the infectious Y pestis strains, compared them with a database of genomes from 131 Y pestis strains from the second and third pandemics, and constructed a maximum likelihood phylogenetic tree. Radiocarbon dating of both individuals (A120 to 533 AD [plus or minus 98 years]; A76 to 504 AD [plus or minus 61 years]) places them in the timeframe of the first pandemic. Our phylogeny contains a novel branch (100% bootstrap at all relevant nodes) leading to the two Justinian samples. This branch has no known contemporary representatives, and thus is either extinct or unsampled in wild rodent reservoirs. The Justinian branch is interleaved between two extant groups, 0.ANT1 and 0.ANT2, and is distant from strains associated with the second and third pandemics. We conclude that the Y pestis lineages that caused the Plague of Justinian and the Black Death 800 years later were independent emergences from rodents into human beings. These results show that rodent species worldwide represent important reservoirs for the repeated emergence of diverse lineages of Y pestis into human populations. McMaster University, Northern Arizona University, Social Sciences and Humanities Research Council of Canada, Canada Research Chairs Program, US Department of Homeland Security, US National Institutes of Health, Australian National Health and Medical Research Council.

Reconstruction of Black Death genome The latest DNA recovery and sequencing technologies have been used to reconstruct the genome of the Yersinia pestis bacterium responsible for the Black Death pandemic of bubonic plague that spread across Europe in the fourteenth century. The genome was pieced together from total DNA extracted from the skeletal remains of four individuals excavated from a large cemetery on the site of the Royal Mint in East Smithfield in London, where more than 2,000 plague victims were buried in 1348 and 1349. The draft genome sequence does not differ substantially from modern Y. pestis strains, providing no answer to the question of why the Black Death was more deadly than modern bubonic plague outbreaks. Technological advances in DNA recovery and sequencing have drastically expanded the scope of genetic analyses of ancient specimens to the extent that full genomic investigations are now feasible and are quickly becoming standard 1 . This trend has important implications for infectious disease research because genomic data from ancient microbes may help to elucidate mechanisms of pathogen evolution and adaptation for emerging and re-emerging infections. Here we report a reconstructed ancient genome of Yersinia pestis at 30-fold average coverage from Black Death victims securely dated to episodes of pestilence-associated mortality in London, England, 1348–1350. Genetic architecture and phylogenetic analysis indicate that the ancient organism is ancestral to most extant strains and sits very close to the ancestral node of all Y. pestis commonly associated with human infection. Temporal estimates suggest that the Black Death of 1347–1351 was the main historical event responsible for the introduction and widespread dissemination of the ancestor to all currently circulating Y. pestis strains pathogenic to humans, and further indicates that contemporary Y. pestis epidemics have their origins in the medieval era. Comparisons against modern genomes reveal no unique derived positions in the medieval organism, indicating that the perceived increased virulence of the disease during the Black Death may not have been due to bacterial phenotype. These findings support the notion that factors other than microbial genetics, such as environment, vector dynamics and host susceptibility, should be at the forefront of epidemiological discussions regarding emerging Y. pestis infections.

The 14th–18th century pandemic of Yersinia pestis caused devastating disease outbreaks in Europe for almost 400 years. The reasons for plague’s persistence and abrupt disappearance in Europe are poorly understood, but could have been due to either the presence of now-extinct plague foci in Europe itself, or successive disease introductions from other locations. Here we present five Y. pestis genomes from one of the last European outbreaks of plague, from 1722 in Marseille, France. The lineage identified has not been found in any extant Y. pestis foci sampled to date, and has its ancestry in strains obtained from victims of the 14th century Black Death. These data suggest the existence of a previously uncharacterized historical plague focus that persisted for at least three centuries. We propose that this disease source may have been responsible for the many resurgences of plague in Europe following the Black Death. A bacterium called Yersina pestis is responsible for numerous human outbreaks of plague throughout history. It is carried by rats and other rodents and can spread to humans causing what we conventionally refer to as plague. The most notorious of these plague outbreaks – the Black Death – claimed millions of lives in Europe in the mid-14th century. Several other plague outbreaks emerged in Europe over the next 400 years. Then, there was a large gap before the plague re-emerged as threat in the 19th century and it continues to infect humans today, though on a smaller scale. Scientists have extensively studied Y. pestis to understand its origin and how it evolved to become such a deadly threat. These studies led to the assumption that the plague outbreaks of the 14–18th centuries likely originated in rodents in Asia and spread along trade routes to other parts of the world. However, it is not clear why the plague persisted in Europe for 400 years after the Black Death. Could the bacteria have gained a foothold in local rodents instead of being reintroduced from Asia each time? If it did, why did it then disappear for such a long period from the end of the 18th century? To help answer these questions, Bos, Herbig et al. sequenced the DNA of Y. pestis samples collected from the teeth of five individuals who died of plague during the last major European outbreak of plague in 1722 in Marseille, France. The DNA sequences of these bacterial samples were then compared with the DNA sequences of modern day Y. pestis and other historical samples of the bacteria. The results showed the bacteria in the Marseille outbreak likely evolved from the strain that caused the Black Death back in the 14th century. The comparisons showed that the strain isolated from the teeth is not found today, and may be extinct. This suggests that a historical reservoir for plague existed somewhere, perhaps in Asia, or perhaps in Europe itself, and was able to cause outbreaks up until the 18th century.Bos, Herbig et al.’s findings may help researchers trying to control the current outbreaks of the plague in Madagascar and other places.

Fifty six Yersinia pestis strains, isolated over the period of more than 50 years in three high-mountain foci of Kyrgyzstan (Tien Shan, Alai, and Talas), have been characterized by means of PCR and single nucleotide polymorphism (SNP) typing methods. Seven of these strains were also characterized by means of whole genome sequencing and genome-wide SNP phylogenetic analysis. It was found that forty two strains belong to 0.ANT2, 0.ANT3 and 0.ANT5 phylogenetic branches. From these, strains of 0.ANT2 and 0.ANT3 branches were earlier detected in China only, whereas 0.ANT5 phylogenetic branch was identified for Y. pestis phylogeny for the first time. According to the results of genome-wide SNP analysis, 0.ANT5 strains are ones of the most closely related to Y. pestis strain responsible for the Justinianic Plague. We have also found out that four of the studied strains belong to the phylogenetic branch 2.MED1, and ten strains from Talas high-mountain focus belong to the phylogenetic branch 0.PE4 (sub-branch 0.PE4t). Established diversity of Y. pestis strains and extensive dissemination of the strains pertaining to the 0.ANT branch confirm the antiquity of the mentioned above plague foci and suggest that strains of the 0.ANT branch, which serve as precursors for all highly virulent Y. pestis strains, had their origin in the Tien Shan mountains.

Ancient genomic studies have identified Yersinia pestis ( Y. pestis ) as the causative agent of the second plague pandemic (fourteenth–eighteenth century) that started with the Black Death (1,347–1,353). Most of the Y. pestis strains investigated from this pandemic have been isolated from western Europe, and not much is known about the diversity and microevolution of this bacterium in eastern European countries. In this study, we investigated human remains excavated from two cemeteries in Riga (Latvia). Historical evidence suggests that the burials were a consequence of plague outbreaks during the seventeenth century. DNA was extracted from teeth of 16 individuals and subjected to shotgun sequencing. Analysis of the metagenomic data revealed the presence of Y. pestis sequences in four remains, confirming that the buried individuals were victims of plague. In two samples, Y. pestis DNA coverage was sufficient for genome reconstruction. Subsequent phylogenetic analysis showed that the Riga strains fell within the diversity of the already known post-Black Death genomes. Interestingly, the two Latvian isolates did not cluster together. Moreover, we detected a drop in coverage of the pPCP1 plasmid region containing the pla gene. Further analysis indicated the presence of two pPCP1 plasmids, one with and one without the pla gene region, and only one bacterial chromosome, indicating that the same bacterium carried two distinct pPCP1 plasmids. In addition, we found the same pattern in the majority of previously published post-Black Death strains, but not in the Black Death strains. The pla  gene is an important virulence factor for the infection of and transmission in humans. Thus, the spread of pla -depleted strains may, among other causes, have contributed to the disappearance of the second plague pandemic in eighteenth century Europe.

The association of historical plague pandemics with Yersinia pestis remains controversial, partly because the evolutionary history of this largely monomorphic bacterium was unknown. The microevolution of Y. pestis was therefore investigated by three different multilocus molecular methods, targeting genomewide synonymous SNPs, variation in number of tandem repeats, and insertion of IS100 insertion elements. Eight populations were recognized by the three methods, and we propose an evolutionary tree for these populations, rooted on Yersinia pseudotuberculosis. The tree invokes microevolution over millennia, during which enzootic pestoides isolates evolved. This initial phase was followed by a binary split 6,500 years ago, which led to populations that are more frequently associated with human disease. These populations do not correspond directly to classical biovars that are based on phenotypic properties. Thus, we recommend that henceforth groupings should be based on molecular signatures. The age of Y. pestis inferred here is compatible with the dates of historical pandemic plague. However, it is premature to infer an association between any modern molecular grouping and a particular pandemic wave that occurred before the 20th century.

The genetic diversity and biovar classification of Yersinia isolates from Central Asia were investigated using whole-genome sequencing. In total, 98 isolates from natural plague foci were sequenced using the MiSeq platform. Computational pipelines were developed for accurate assembly of Y. pestis replicons, including small cryptic plasmids, and for identifying genetic polymorphisms. A panel of 99 diagnostic polymorphisms was established, enabling the distinction of dominant Medievalis isolates derived from desert and upland regions. Evidence of convergent evolution was observed in polymorphic allele distributions across genetically distinct Y. pestis biovars, Y. pseudotuberculosis , and other Y. pestis strains, likely driven by adaptation to similar environmental conditions. Genetic polymorphisms in the napA , araC , ssuA , and rhaS genes, along with transposon and CRISPR-Cas insertion patterns, were confirmed as suitable tools for identifying Y. pestis biovars, although their homoplasy suggests limited utility for phylogenetic inference. Notably, a novel cryptic plasmid, pCKF, previously associated with the strain of the population 2.MED0 from the Central-Caucasus high-altitude autonomous plague focus, was detected in a genetically distinct isolate of 2.MED1 population from the Ural-Embi region, indicating potential plasmid transfer across the 2.MED lineage. These findings emphasize the need for ongoing genomic surveillance to monitor the spread of virulence-associated genetic elements and to improve our understanding of Y. pestis evolution and ecology.