“…The proventriculus, which separates the stomach and esophagus, is a sphincter-like organ with needle-like teeth directed back toward the stomach; it aids in the rupture of blood cells and normally prevents regurgitation of a blood meal (5,6,50). Between days 3 and 9 after the infected blood meal, the bacterial masses may completely block the proventriculus, extend into the esophagus, and prevent ingested blood from reaching the stomach (4,5,6,25,50,289). As the hungry flea repeatedly attempts to feed, the blood sucked from the mammalian host distends the esophagus, mixes with bacilli, and is regurgitated into the mammalian host when the feeding attempt is terminated (5,50).…”