WEBVTT - Ep 78 Bartonella: Keep Calm and Carrión 0:00:01.560 --> 0:00:03.840 On one occasion I spent the night with the brigade 0:00:03.880 --> 0:00:06.480 machine gun officer and the signals officer in one of 0:00:06.480 --> 0:00:09.400 the captured German dugouts. We tossed down for the night 0:00:09.440 --> 0:00:11.200 in the hopes of getting some sleep, but it was 0:00:11.200 --> 0:00:14.280 not to be. We no sooner lay down than hordes 0:00:14.320 --> 0:00:16.560 of lice got up. So we went round to the 0:00:16.560 --> 0:00:19.440 medical officer, who was also in the duckout with his equipment, 0:00:19.680 --> 0:00:21.639 and he gave us some ointment which he assured us 0:00:21.640 --> 0:00:24.720 would keep the little brutes away. We anointed ourselves all 0:00:24.720 --> 0:00:27.320 over with the stuff and again lay down in great hopes. 0:00:27.680 --> 0:00:30.720 But it was not to be, because instead of discouraging them, 0:00:30.760 --> 0:00:33.360 it seemed to act like a kind of ord'uv, and 0:00:33.440 --> 0:00:36.360 the little beggars went at their feast with renewed vigor. 0:00:37.360 --> 0:00:39.680 A full day's rest allowed us to clean up a 0:00:39.680 --> 0:00:42.520 bit and to launch a full scale attack on lice. 0:00:43.120 --> 0:00:45.239 I sat in a quiet corner of a barn for 0:00:45.280 --> 0:00:49.000 two hours, delapsing myself as best I could. We were 0:00:49.040 --> 0:00:52.200 all at it, for none of us escaped their vile attentions. 0:00:52.600 --> 0:00:55.160 The things lay in the seams of trousers and the 0:00:55.200 --> 0:00:59.200 deep furrows of long, thick wooly pants and seemed impregnable 0:00:59.240 --> 0:01:02.440 in their deep and trenchments. A lighted candle applied where 0:01:02.480 --> 0:01:05.720 they were thickest made them pop. After a session of this, 0:01:05.959 --> 0:01:08.520 my face would be covered with small blood spots from 0:01:08.640 --> 0:01:12.800 extra big fellows which had popped too vigorously. Lice hunting 0:01:12.920 --> 0:01:16.360 was called chatting. In parcels from home, it was usual 0:01:16.400 --> 0:01:20.000 to receive a tin of supposedly death dealing powder or palmade, 0:01:20.360 --> 0:01:22.640 but the lice thrived on the stuff. 0:01:23.720 --> 0:01:26.120 We had to sleep fully dressed. Of course, this was 0:01:26.240 --> 0:01:29.200 very uncomfortable, with the pressure of ammunition on one's chest 0:01:29.280 --> 0:01:33.160 restricted breathing. Furthermore, when a little warmth was obtained, the 0:01:33.240 --> 0:01:37.119 vermin used to get busy, and for some unexplained reason, 0:01:37.319 --> 0:01:39.720 they always seemed to get lively in the portion of 0:01:39.800 --> 0:01:42.960 one's back that lay underneath the belt and was the 0:01:43.000 --> 0:01:47.080 most inaccessible spot. The only way to obtain relief was 0:01:47.120 --> 0:01:49.400 to get out of the duckout, put a rifle barrel 0:01:49.400 --> 0:01:51.400 between the belt and rub up and down like a 0:01:51.440 --> 0:01:54.360 donkey at a gate post. This stopped it for a bit, 0:01:54.520 --> 0:01:56.680 but as soon as one got back into the dugout 0:01:57.000 --> 0:01:59.919 and was getting reasonably warm, so would the little brutes 0:02:00.240 --> 0:02:47.400 get going again. That's really funny. 0:02:49.560 --> 0:02:55.119 So those were all accounts of lice during trench warfare 0:02:55.240 --> 0:02:56.280 during World War One. 0:02:56.639 --> 0:02:58.400 It sounds truly awful. 0:02:58.480 --> 0:03:02.320 Erin, I just can't imagine. And I also have some 0:03:02.480 --> 0:03:04.760 numbers that I'll share later on just to kind of 0:03:04.800 --> 0:03:07.720 like put an even more horrific spin to this. 0:03:08.040 --> 0:03:13.120 Yeah, I lice, fleas, all the little things that just 0:03:13.800 --> 0:03:14.920 don't stop biting you. 0:03:15.880 --> 0:03:16.760 I know, I know. 0:03:17.800 --> 0:03:18.160 Yeah. 0:03:18.160 --> 0:03:22.400 By the way, those were from various soldiers from World 0:03:22.480 --> 0:03:25.639 War One and we will post the full names and 0:03:25.919 --> 0:03:29.359 links and whatever on our website. And also, Hi, I'm 0:03:29.440 --> 0:03:33.040 Erin Welsh and I'm Erin alman Updyke and this is 0:03:33.240 --> 0:03:34.720 this podcast We'll kill. 0:03:34.560 --> 0:03:38.440 You, And welcome to a very weird episode today. 0:03:38.600 --> 0:03:43.880 Yeah, we did not intend for this episode to be. 0:03:44.960 --> 0:03:47.520 We had no idea what we were getting into. We 0:03:47.560 --> 0:03:49.360 thought this was going to be a run of the 0:03:49.400 --> 0:03:54.080 mill episode. Yeah, and it's not. But that's okay. 0:03:54.680 --> 0:03:58.640 We were very wrong, but that means we learned something new. 0:03:58.960 --> 0:04:04.600 Yeah, of new things. Yeah, so what are we covering today, Aaron. 0:04:04.680 --> 0:04:09.320 Well, it's a good question. We're covering the genus Bartonella, 0:04:10.360 --> 0:04:13.680 which causes a whole bunch of diseases, some of which 0:04:13.840 --> 0:04:17.000 listeners you may have heard of, like cat scratch disease 0:04:17.279 --> 0:04:22.520 for example, also trench fever hence the lice in trenches, 0:04:22.920 --> 0:04:27.880 firs stand accounts, and also carry On's disease, Yeah, which 0:04:27.920 --> 0:04:30.240 you may not have heard of because I hadn't. 0:04:30.360 --> 0:04:34.680 Really I hadn't either, but I learned a lot about it, 0:04:35.080 --> 0:04:37.960 and I think it's actually going to be fun to do. 0:04:38.560 --> 0:04:40.320 I'm excited about it. I think it's going to be 0:04:40.600 --> 0:04:42.640 it's going to be at least I don't know something new. 0:04:42.839 --> 0:04:45.279 Yeah, yeah, And so this episode is going to be 0:04:45.279 --> 0:04:48.480 formatted a little bit differently, just as an explanation. What 0:04:48.480 --> 0:04:52.000 we're going to do is we'll go through the biology history, 0:04:52.080 --> 0:04:56.040 biology history, biology history in sort of like three mini 0:04:56.120 --> 0:04:59.080 episodes almost, and then we'll wrap it up with a 0:04:59.200 --> 0:05:02.240 current status. And that's kind of how it'll be. 0:05:02.800 --> 0:05:04.920 It's like three episodes for the price so one. 0:05:05.080 --> 0:05:09.200 Yeah, I'm saying, yeah, look at it that way. Certainly 0:05:09.240 --> 0:05:12.520 the work felt like three episodes for the price of one. Yep. 0:05:15.320 --> 0:05:18.320 So, speaking of which, I think it's about quarantine Hede. 0:05:18.480 --> 0:05:21.120 It is of what are we drinking this week? 0:05:21.480 --> 0:05:24.400 We're drinking a game of Cat and Laos. 0:05:24.600 --> 0:05:26.360 I love this name. 0:05:26.800 --> 0:05:30.200 I also do too, even though the cat scratches really 0:05:30.279 --> 0:05:33.240 flees more than lace, but I know it's still really good. 0:05:33.560 --> 0:05:35.560 Yeah. 0:05:34.520 --> 0:05:37.559 What's in a game of Cat and Laus? Aaron? 0:05:38.320 --> 0:05:42.960 In a game of Cat and Laos is gin peach nectar, 0:05:43.480 --> 0:05:47.080 sparkling water, some lemon juice, and then garnish it with 0:05:47.240 --> 0:05:50.440 a little fresh sprig of rosemary. Yum. 0:05:51.040 --> 0:05:54.240 Yeah, and we'll post the full recipe for that quarantini 0:05:54.320 --> 0:05:57.360 as well as our non alcoholic place Bareta, on our website, 0:05:57.400 --> 0:05:59.440 this podcast We Kill You dot com, and on all 0:05:59.440 --> 0:06:01.920 of our social media channels as always. 0:06:01.839 --> 0:06:07.960 As always, and business our website, you can find lots 0:06:07.960 --> 0:06:11.560 of things. You can find transcripts, you can find our 0:06:11.600 --> 0:06:14.240 references to all of the episodes. You can find a 0:06:14.279 --> 0:06:18.320 good Reads list, a bookshop dot Org affiliate account, a 0:06:18.520 --> 0:06:21.720 link to all of our promo codes that we talk 0:06:21.800 --> 0:06:26.280 about in the ads Patreon. I mean, I'm probably missing 0:06:26.320 --> 0:06:30.800 many things, merch but if I've missed it, just go 0:06:30.839 --> 0:06:32.840 to our website and you'll be able to find it there. 0:06:34.640 --> 0:06:35.920 It's true, there's a lot there. 0:06:36.120 --> 0:06:39.400 Yeah. All right, Well, should we get started on this 0:06:39.640 --> 0:06:41.160 very unusual episode? 0:06:41.520 --> 0:06:44.000 I yeah, I'm excited about it. Let's take a break 0:06:44.040 --> 0:07:13.960 and then dive into the first of three minisodes. Yeah, 0:07:14.280 --> 0:07:19.160 so suffice to say, I severely underestimated the genus Bartanella. 0:07:19.520 --> 0:07:23.160 Oh, same, same, same, So just. 0:07:23.360 --> 0:07:26.040 Upfront, what I'm going to do in this biology section 0:07:26.240 --> 0:07:29.000 is kind of go over the genus and all of 0:07:29.040 --> 0:07:32.880 the general things that we know about the genus Bartanella 0:07:32.920 --> 0:07:36.840 and the many species of bacteria that cause disease in 0:07:37.000 --> 0:07:41.120 humans and other animals, and just sort of go over 0:07:41.160 --> 0:07:45.880 the similarities and then focus on one specific species, and 0:07:45.920 --> 0:07:50.520 that is Bartanella bacilliformis, and that's aaron what you're going 0:07:50.600 --> 0:07:54.440 to then cover, et cetera, et cetera. Okay, And what 0:07:54.800 --> 0:07:57.960 makes this even more confusing is that even though we're 0:07:58.000 --> 0:08:03.840 going to focus on three specific bacterial species, there's like 0:08:04.040 --> 0:08:07.120 five or six or maybe seven, depending on how you 0:08:07.160 --> 0:08:09.680 count them, different diseases that they cause. 0:08:10.920 --> 0:08:15.000 Yeah, and there are some species that are not human 0:08:15.040 --> 0:08:19.679 specific or like not commonly human pathogens, but do infect humans. 0:08:19.680 --> 0:08:22.440 But we're not gonna go into those, yep. 0:08:22.560 --> 0:08:27.440 So let's talk about them all in general, shall we. Yes, So, 0:08:27.960 --> 0:08:34.840 in general, the genus Bartanella are small, fastidious, which we 0:08:34.960 --> 0:08:36.840 know means difficult to grow in culture. 0:08:36.920 --> 0:08:37.600 I love that word. 0:08:38.160 --> 0:08:41.440 I know it's such a good word. Gram negative rod 0:08:41.520 --> 0:08:46.160 shaped bacteria. There are dozens of species over thirty that 0:08:46.200 --> 0:08:50.760 we've identified so far, but again we're gonna focus on 0:08:51.040 --> 0:08:54.800 three today. But know that there are others that can 0:08:54.840 --> 0:08:58.040 cause some of these same diseases, and there's probably more 0:08:58.040 --> 0:09:00.600 that we just don't know about yet. I think that aarin, 0:09:00.640 --> 0:09:03.040 you're gonna talk a little bit more about the overarching 0:09:03.120 --> 0:09:07.080 evolutionary history. But it does seem that there are a 0:09:07.120 --> 0:09:10.720 lot of species that are relatively specific to certain mammals, 0:09:10.760 --> 0:09:13.400 like there are some species mostly found in rats, and 0:09:13.520 --> 0:09:17.320 others mostly found in cows or cats, et cetera. Yeap, 0:09:18.040 --> 0:09:20.480 and there's two species that will focus on today that 0:09:20.480 --> 0:09:24.600 are specific to humans, and then another species that commonly 0:09:24.640 --> 0:09:30.640 infects humans even though it's a feline species. Simple, simple, 0:09:30.760 --> 0:09:36.119 no problem, No one's confused yet. In general, these bacteria 0:09:36.200 --> 0:09:41.280 are transmitted to these mammalian usually mammalian hosts, by blood 0:09:41.280 --> 0:09:46.120 feeding arthropod vectors. But of course they're not simple, so 0:09:46.160 --> 0:09:50.559 it's not like just one type. Sometimes it's sandflies, sometimes 0:09:50.559 --> 0:09:53.800 it's lice, sometimes it's fleas. Maybe it could even be ticks. 0:09:54.000 --> 0:09:59.840 Some people are saying mm oh goodness, and if anyone 0:10:00.200 --> 0:10:03.400 listening has heard of cat scratch disease, you might already 0:10:03.480 --> 0:10:07.920 be scratching your head, scratching like I'm sorry, I thought 0:10:07.920 --> 0:10:11.719 the cat scratch disease was from cat scratches. And we'll 0:10:11.720 --> 0:10:16.760 get there. People will get there. But for the most part, 0:10:16.800 --> 0:10:20.440 these are vector born pathogens. But to make it even 0:10:20.480 --> 0:10:24.880 more confusing, unlike many vector born pathogens that we've covered 0:10:24.920 --> 0:10:28.280 on this podcast that are picked up in the blood 0:10:28.280 --> 0:10:31.720 stream and then spit out in their next blood meal 0:10:31.760 --> 0:10:36.520 to infect another host, these ones are sometimes transmitted that way, 0:10:36.720 --> 0:10:40.880 like when it's sandflies, but sometimes they are picked up 0:10:40.880 --> 0:10:43.920 in a blood meal and then replicate in the guts 0:10:44.080 --> 0:10:47.440 and then are pooped onto the mammal and then have 0:10:47.520 --> 0:10:51.240 to be scratched into a bite wound. So these are 0:10:51.240 --> 0:10:57.800 complicated bacteria, yeah, And then once they get inside their 0:10:57.880 --> 0:11:02.400 mammalian host to be even more complex. Bartnella exists as 0:11:02.679 --> 0:11:09.080 intracellular bacteria, so they don't just live inside us and 0:11:09.200 --> 0:11:14.559 replicate like say staff or strep or many other bacterial species. 0:11:14.600 --> 0:11:17.840 But they're more like Legionella that we just talked about, 0:11:18.080 --> 0:11:23.000 or chlamydia, gonorrhea, et cetera. They enter ricketsia, they go 0:11:23.120 --> 0:11:25.680 inside of our cells and replicate the way that viruses 0:11:25.760 --> 0:11:29.440 do in mammals, not in the arthropod vector. 0:11:30.000 --> 0:11:31.119 It's kind of impressive. 0:11:31.920 --> 0:11:36.280 I know, it's very cool. They're facultatively intracellular. Yeah, it's 0:11:36.559 --> 0:11:40.520 very very awesome. So that was all the really complex part. 0:11:40.640 --> 0:11:44.040 Let's talk about what they all have in common once 0:11:44.040 --> 0:11:48.959 they're in mammalian hosts, because it's actually kind of simple 0:11:49.280 --> 0:11:51.679 and tells us a lot about the diseases that they 0:11:51.720 --> 0:11:56.400 tend to cause. So, in mammals, Bartanella tend to infect 0:11:56.520 --> 0:11:59.920 two different cell types, two different kind of tissue types, 0:12:00.760 --> 0:12:05.960 red blood cells, erythrocytes and endothelial cells, which are the 0:12:06.000 --> 0:12:08.600 cells that line our blood vessels and can also be 0:12:08.640 --> 0:12:11.400 found in places like lymph nodes. They can also infect 0:12:11.440 --> 0:12:16.000 white blood cells and those two cell types. Infecting and 0:12:16.080 --> 0:12:19.320 causing damage to those two cell types actually explains a 0:12:19.400 --> 0:12:22.000 lot of what we see in terms of the actual 0:12:22.120 --> 0:12:25.600 symptoms of disease. Right, So at least that's one thing 0:12:25.640 --> 0:12:28.760 that they tend to have in common. Asterisk cat scratch 0:12:28.840 --> 0:12:35.520 disease is weird, all right, So that was all of 0:12:35.520 --> 0:12:41.760 the general details. Let's focus now on one species, Bartonella bacilliformis. Listeners, 0:12:41.800 --> 0:12:43.640 you may have never heard of this, because I had 0:12:43.679 --> 0:12:48.559 never even heard of it. This is a particular species 0:12:49.280 --> 0:12:53.320 that is human specific, so it doesn't infect, as far 0:12:53.360 --> 0:12:57.400 as we can tell, other mammals, at least not naturally, 0:12:58.640 --> 0:13:02.000 and it causes a disease no known as Carrion's disease. 0:13:02.800 --> 0:13:06.680 My accent is probably terrible on that, but also sometimes 0:13:06.800 --> 0:13:10.160 Carrion's disease is called two different diseases because this is 0:13:10.160 --> 0:13:14.079 a bi phasic illness, so there's an acute stage and 0:13:14.120 --> 0:13:17.360 then a potential chronic stage. And these two phases are 0:13:17.520 --> 0:13:18.760 completely different. 0:13:19.520 --> 0:13:24.920 That is fascinating, and I don't understand it, and I 0:13:25.040 --> 0:13:27.720 kept confusing the two phases, and. 0:13:28.120 --> 0:13:31.800 Yeah, well, hopefully when I explain it, the two phases 0:13:31.840 --> 0:13:33.480 will make at least a little bit more sense. 0:13:33.960 --> 0:13:34.320 Okay. 0:13:34.679 --> 0:13:38.880 So this particular species is vectored by sandflies in the 0:13:38.920 --> 0:13:42.800 same genus that we talked about with leshmaniasis of all things, 0:13:43.480 --> 0:13:45.120 Lutzomia sand flies. 0:13:45.240 --> 0:13:45.480 Yep. 0:13:46.920 --> 0:13:49.880 And part of the reason that many listeners may have 0:13:49.920 --> 0:13:52.760 never heard of it is that it's very geographically limited 0:13:52.800 --> 0:13:56.240 to certain parts of the Andean valleys in South America, 0:13:56.600 --> 0:14:00.000 so Peru, Ecuador, and Colombia, and only parts of those countries. 0:14:00.280 --> 0:14:04.200 It's like a really narrow altitudinal range, right, Yes, and 0:14:04.240 --> 0:14:07.800 it's where this particular sandfly species is found. 0:14:08.240 --> 0:14:13.160 Yeah. Yeah. So let's go over the symptoms of this 0:14:13.320 --> 0:14:17.400 one disease, Carrion's disease, which is sometimes called two different diseases. 0:14:18.120 --> 0:14:21.080 In the acute stage, which happens the first time that 0:14:21.160 --> 0:14:26.240 somebody gets infected, and the symptoms start usually about sixty 0:14:26.360 --> 0:14:30.320 days after infection, so it's a really long incubation period. 0:14:30.440 --> 0:14:32.680 WHOA, I did not know it was so long. 0:14:33.000 --> 0:14:35.800 Yeah, And some estimates that I saw ranged from ten 0:14:35.920 --> 0:14:39.960 to two hundred days. And I wonder how much of 0:14:39.960 --> 0:14:42.120 that variability just has to do with how little we 0:14:42.200 --> 0:14:44.600 really know about this disease quite honestly. 0:14:44.600 --> 0:14:46.680 Yeah, this was like, this was the one that was 0:14:46.760 --> 0:14:48.760 the most difficult to get information on. 0:14:48.840 --> 0:14:50.280 I think absolutely. 0:14:51.080 --> 0:14:51.200 So. 0:14:51.320 --> 0:14:55.240 The acute stage of Carrion's disease is sometimes called auroya fever. 0:14:56.720 --> 0:15:01.720 What it looks like is a headache, some general feeling 0:15:01.880 --> 0:15:07.680 cruddy like malaise, maybe some joint pain, bone pain, and 0:15:07.720 --> 0:15:11.160 that will progress to chills and a fever. But then 0:15:11.240 --> 0:15:14.520 over the course of one to four weeks, this becomes 0:15:14.640 --> 0:15:20.400 much much worse. People infected become pale, jaundiced, they might 0:15:20.440 --> 0:15:26.520 have difficulty breathing, they might become confused, and this can 0:15:26.560 --> 0:15:33.280 progress to multi organ failure and death. And some reports 0:15:33.320 --> 0:15:36.600 say that the mortality rate is anywhere from forty to 0:15:36.760 --> 0:15:39.280 eighty eight percent if untreated. 0:15:40.760 --> 0:15:43.040 Yeah, which blew me away. 0:15:43.760 --> 0:15:46.440 Yeah. Same, And I'm going to talk about it in 0:15:46.480 --> 0:15:48.800 a little bit more detail in a second, but first 0:15:48.840 --> 0:15:51.640 I want to talk about what's happening in this acute 0:15:51.640 --> 0:15:54.080 phase of the disease because it goes back to what 0:15:54.120 --> 0:15:58.480 we already know about this genus of bacteria. What's happening 0:15:58.480 --> 0:16:02.160 in this acute phase is that these bacteria are multiplying 0:16:03.040 --> 0:16:05.840 inside of our red blood cells. We know that that's 0:16:05.880 --> 0:16:08.640 one of the cells they like to infect, but in 0:16:08.680 --> 0:16:14.320 the case of this particular species, Bartnella bacilliformis these bacteria 0:16:14.400 --> 0:16:20.720 replicate rapidly and enormously into like huge numbers, and then 0:16:21.160 --> 0:16:24.800 they end up bursting open those red blood cells. So 0:16:24.920 --> 0:16:29.960 this can cause a severe hemolytic anemia that combined with 0:16:30.040 --> 0:16:33.120 secondary bacterial infection, is what often causes death. 0:16:33.680 --> 0:16:36.280 Why is there secondary bacterial infection. 0:16:36.840 --> 0:16:42.680 I'm not entirely clear, but likely it's just how overwhelmed 0:16:42.680 --> 0:16:45.120 the immune system is already makes you more susceptible to 0:16:45.160 --> 0:16:49.760 secondary infection. You have an overwhelming bacteremia, so so much 0:16:49.840 --> 0:16:52.640 bacteria in your blood already, your immune systems probably just 0:16:52.640 --> 0:16:56.560 not able to fight off other organisms. 0:16:56.360 --> 0:17:02.400 And so in that very why incubation period, once symptoms 0:17:02.480 --> 0:17:05.440 do start to appear, what's sort of the timeline there. 0:17:05.600 --> 0:17:08.199 From what I could gather a number of weeks, So 0:17:08.320 --> 0:17:10.560 one to four weeks is when these symptoms sort of 0:17:10.640 --> 0:17:15.360 start and then progress. Okay, but I want to get 0:17:15.400 --> 0:17:18.639 into it a little bit more because there's actually some 0:17:18.720 --> 0:17:21.479 evidence from some more recent outbreaks that have happened in 0:17:21.560 --> 0:17:25.120 non endemic areas that the mortality rate might actually be 0:17:25.200 --> 0:17:28.560 a lot lower, not just because of good treatment, which 0:17:28.560 --> 0:17:32.359 can certainly help, but it's likely the case that there's 0:17:32.400 --> 0:17:37.480 actually a lot more subacute or subclinical like not symptoms 0:17:37.560 --> 0:17:41.120 or barely any symptoms where people get infected but they 0:17:41.119 --> 0:17:45.000 don't even really know that they're sick. That happens that 0:17:45.160 --> 0:17:47.399 we didn't know about when it was just the people 0:17:47.760 --> 0:17:49.600 coming in really really sick, and then dying. Does that 0:17:49.640 --> 0:17:50.080 make sense? 0:17:50.320 --> 0:17:54.560 Yeah, No, I saw that also, and it maybe wonder 0:17:55.720 --> 0:17:58.119 why does that happen, Like why are there certain people 0:17:58.240 --> 0:18:01.879 because like from the history, so it doesn't seem to 0:18:01.880 --> 0:18:05.800 be like people who are already like immunocompromise. It doesn't 0:18:05.840 --> 0:18:09.600 seem to be like people who are in advanced age 0:18:09.720 --> 0:18:12.080 that are more likely to die. It just seems sort 0:18:12.119 --> 0:18:13.920 of random, almost. 0:18:13.680 --> 0:18:17.320 Right, Yeah, I honestly don't know. This was a disease 0:18:17.359 --> 0:18:20.920 that was really difficult to get like super clear information 0:18:21.040 --> 0:18:23.000 on likely because it is pretty rare. 0:18:24.200 --> 0:18:28.000 And then those non endemic areas, that is where it 0:18:28.320 --> 0:18:30.840 might be a different species of sand fly. 0:18:31.240 --> 0:18:35.080 Or potentially different species of sandfly, which could mean like 0:18:35.119 --> 0:18:39.320 a variant of the pathogen itself, So who really knows, 0:18:39.400 --> 0:18:40.040 quite honestly. 0:18:40.200 --> 0:18:41.000 Yeah. 0:18:41.160 --> 0:18:44.000 But in those outbreaks, though, what they found is that 0:18:44.119 --> 0:18:48.119 over seventy five percent of a population had antibodies, so 0:18:48.200 --> 0:18:51.400 lots of people were getting infected, but only about fourteen 0:18:51.440 --> 0:18:55.360 percent had symptoms of or ruya fever this initial infection, 0:18:55.920 --> 0:18:58.879 and then about seventeen percent went on to develop the 0:18:58.960 --> 0:19:02.040 chronic form. And what's even more interesting is that only 0:19:02.160 --> 0:19:05.959 five percent had this biphasic illness where they first had 0:19:06.000 --> 0:19:09.320 to arroya fever and then they went on to develop 0:19:09.400 --> 0:19:12.200 chronic form. But a lot of people had the chronic 0:19:12.280 --> 0:19:15.200 form quote unquote chronic without ever having symptoms of a 0:19:15.280 --> 0:19:15.840 royal fever. 0:19:17.040 --> 0:19:20.879 Okay, that is very interesting. So one of the questions 0:19:20.920 --> 0:19:24.239 that came up while I was reading was that, you know, 0:19:24.320 --> 0:19:28.800 it seems that this is human specific, and so that 0:19:28.840 --> 0:19:31.440 means that there would be no reservoir animal that we've 0:19:31.480 --> 0:19:37.240 found yet, and so are people just like reinfecting the 0:19:37.320 --> 0:19:41.240 flies forever? Like, how has this not burned through unless 0:19:41.280 --> 0:19:45.240 it is this high rate of subclinical cases that lead 0:19:45.320 --> 0:19:50.000 to just persistent like pathogen presence exactly. 0:19:50.040 --> 0:19:53.000 And honestly that that probably is what it is based 0:19:53.000 --> 0:19:57.640 on how Bartonella exists in so many other reservoir species. Right, 0:19:57.720 --> 0:20:01.919 it's very common to have a chronic bloodstream infection that 0:20:02.040 --> 0:20:04.760 kind of you'll have a lot of bacteria in the 0:20:04.760 --> 0:20:08.240 bloodstream and then you know, the numbers will decrease and 0:20:08.280 --> 0:20:11.480 it'll sort of cycle like that, even without having any symptoms. 0:20:11.920 --> 0:20:12.240 Yeah. 0:20:13.000 --> 0:20:17.800 So, but speaking of symptoms, the chron quote unquote chronic 0:20:18.200 --> 0:20:21.160 disorder that you can get which can happen I didn't 0:20:21.160 --> 0:20:24.760 get a timeline on how long after initial infection this 0:20:24.840 --> 0:20:30.200 tends to happen. But what can happen over a course 0:20:30.240 --> 0:20:36.200 of time is a disorder known as viruga peruana. And 0:20:36.240 --> 0:20:40.639 this is a cutaneous so a skin disease, and you 0:20:40.760 --> 0:20:46.760 get these little vascular tumors. Really, these little lumps or 0:20:46.800 --> 0:20:51.720 bumps or nodules. They look like little red or sometimes 0:20:51.760 --> 0:20:57.720 purple almost black, raised moles, like not quite wordy looking, 0:20:58.119 --> 0:21:01.639 but almost like a very red or per purple lumpy 0:21:01.800 --> 0:21:05.760 lump just stuck onto your skin, right, yeah, And they 0:21:05.760 --> 0:21:08.160 can actually have quite a lot of different appearances. Sometimes 0:21:08.160 --> 0:21:10.159 that's what they look like. And they're little and tiny, 0:21:10.240 --> 0:21:13.359 like less than three millimeters and just all over your body, 0:21:13.440 --> 0:21:16.639 especially on your arms and legs. Sometimes they can be 0:21:16.640 --> 0:21:20.200 a bit larger or even have like multiple little nubbins 0:21:20.359 --> 0:21:24.920 all in one, or sometimes it can manifest with deeper 0:21:25.080 --> 0:21:29.280 kind of subdermal nodules. And when those are present near 0:21:29.320 --> 0:21:31.480 a bone, like say right on top of your shin, 0:21:31.600 --> 0:21:35.199 for example, those can be kind of painful. But the 0:21:35.280 --> 0:21:38.320 reason that these are red to purple to dark black 0:21:38.440 --> 0:21:42.600 in color is because they're actually derived from vascular tissue. 0:21:42.920 --> 0:21:47.320 So these little lesions are made from blood vessels that proliferate. 0:21:48.040 --> 0:21:50.680 That's wild, uh huh, But. 0:21:50.720 --> 0:21:54.320 It's not that wild when you know that this bacteria 0:21:54.440 --> 0:21:58.000 infects the lining of our blood vessels. So it's basically 0:21:58.040 --> 0:22:02.000 just the bacteria causing peration of blood vessels in which 0:22:02.000 --> 0:22:02.480 it lives. 0:22:02.920 --> 0:22:05.280 That is ridiculous. 0:22:05.600 --> 0:22:10.840 Uh huh, wow, I know. And so these continue to 0:22:10.880 --> 0:22:13.800 develop often over the course of three to six months. 0:22:14.320 --> 0:22:17.480 You can imagine that because these are literally like made 0:22:17.480 --> 0:22:20.720 from blood vessels, it's very easy if you scratch them 0:22:20.720 --> 0:22:23.600 for them to open and bleed pretty profusely, more than 0:22:23.680 --> 0:22:26.159 like a normal mole would bleed if you scratched it, 0:22:26.840 --> 0:22:29.600 especially on the arms and legs. But in general, they 0:22:29.640 --> 0:22:33.040 tend to heal on their own, even without antibiotic treatment. 0:22:33.800 --> 0:22:34.760 Huh okay. 0:22:35.119 --> 0:22:37.879 Yeah, it's a very interesting and I think that a 0:22:37.960 --> 0:22:39.879 large part of the reason that they are able to 0:22:39.920 --> 0:22:42.960 heal on their own is because in general, with this 0:22:43.119 --> 0:22:47.040 disorder Veruga peruana, or the chronic form of carrion disease, 0:22:48.000 --> 0:22:51.480 these nodules tend to be limited to the skin and 0:22:51.640 --> 0:22:55.000 maybe a little bit deeper into like the subcutaneous tissue 0:22:55.119 --> 0:22:58.400 or maybe rarely the muscle, but they don't go any 0:22:58.440 --> 0:23:01.960 deeper than that. That's an important for a different disease 0:23:02.040 --> 0:23:08.359 that we'll talk about later. Okay, who was that enough? 0:23:08.440 --> 0:23:10.840 That was a lot, Aarin, No, I feel like I 0:23:10.880 --> 0:23:13.600 feel like this is going to be instead of three minisods, 0:23:13.640 --> 0:23:19.480 this is going to be three full maxi sense full maxisos. 0:23:20.040 --> 0:23:22.199 But so that kind of sums up the genus that 0:23:22.320 --> 0:23:26.440 is Bartonella and then Bartonella bacilliformis in specific. I think 0:23:26.480 --> 0:23:29.959 that that particular species is a good example of not 0:23:30.000 --> 0:23:33.240 only how severe this disease can get, but also why 0:23:33.400 --> 0:23:36.400 it's able to cause the diseases that it causes. Right, 0:23:37.720 --> 0:23:40.760 we'll go over the other two species that most commonly 0:23:40.800 --> 0:23:44.680 cause disease in humans later. But Aarin, first off, can 0:23:44.720 --> 0:23:46.800 you walk us through the history of this disease. 0:23:47.240 --> 0:23:50.159 I can, and we don't even have to take a 0:23:50.200 --> 0:23:55.359 break first. Yes, So, like you, Aaron, I wanted to 0:23:55.480 --> 0:23:58.480 start out with a general overview of the group of 0:23:58.520 --> 0:24:01.920 bacteria that we're talking about today, because even though the 0:24:02.000 --> 0:24:05.119 human histories of each of the three species we're talking 0:24:05.119 --> 0:24:08.480 about are very distinct from one another, being in the 0:24:08.560 --> 0:24:12.000 same genus of course means that they share an evolutionary 0:24:12.080 --> 0:24:16.600 history and it turns out that evolutionary history is actually 0:24:16.680 --> 0:24:17.760 pretty interesting. 0:24:18.320 --> 0:24:18.880 Of course. 0:24:19.080 --> 0:24:23.680 Uh so, the genus Bartanella is a fairly like you mentioned, 0:24:24.080 --> 0:24:28.240 diverse group of bacteria that tends to, though not always 0:24:28.600 --> 0:24:33.719 show high host specificity for its mammalian host or arthropod vector. 0:24:34.480 --> 0:24:37.880 And side note, it wasn't always known to be diverse. 0:24:38.720 --> 0:24:42.159 Until nineteen ninety three, the genus consisted I think of 0:24:42.400 --> 0:24:44.840 just Bartanella bacilliformis. 0:24:44.480 --> 0:24:47.600 Yeah, which is so fascinating to me. I didn't realize 0:24:47.640 --> 0:24:49.919 how recent it was that we even knew that like 0:24:50.040 --> 0:24:54.240 cat scratch fever or cat scratch disease and trench fever 0:24:54.440 --> 0:24:57.440 were caused by bacteria in the same genus, Like it's 0:24:57.480 --> 0:24:58.280 super recent. 0:24:58.640 --> 0:25:02.239 Yeah, it is really, and part of that recency, like 0:25:02.480 --> 0:25:05.960 we knew about some of those pathogens before, but this 0:25:06.160 --> 0:25:08.919 was just like merging with another genus and so it 0:25:08.960 --> 0:25:12.880 was sort of just like this restructuring of naming and grouping, 0:25:13.119 --> 0:25:16.520 and it does make looking at old papers more difficult 0:25:16.720 --> 0:25:19.919