THE Epidemic Typhus, as isolated and identified by

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Last updated: October 2, 2019

THEHISTORICAL ACCOUNT OF EPIDEMIC TYPHUSINTRODUCTIONLouseborne typhus is one of the oldest pernicious diseases, that has been hauntingmankind.

Known by the many names such as “camp fever”, “war fever”, “jailfever” and “tabarillo” and confused with many other fevers and diseases, it wasonly in the late 15th century, it was identified as a cause of majorepidemics. With Plague, Typhoid, and Dysentery, it is known to have wiped out armiesand civilian populations from the 15th to the 20th century, playing a decisiverole in the fate of wars in Europe. This paper will attempt to further analyse  the historical impact of Louse-borne Typhusand how its epidemic propagation has led many to regard Pediculus humanuscorporis to have a more remarkable influence on human history than anyother parasite.EPIDEMICTYPHUS FEVER (TABARILLO, CLASSIC OR EUROPEAN TYPHUS, JAIL FEVER, WAR FEVER)Thedenomination “typhus” was derived from the Greek word typhos, meaning”smoke” resembling the deliriousstate, that one suffers from, during infection. Originally,”typhus” represented any of the self-limiting fevers accompanied bystupor.

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In 1829, the French clinician Louis demarcated ‘Typhus Fever’ from’Typhoid Fever’.CausativeAgent and transmission : Epidemic Typhus, as isolated andidentified by DaRocha-Lima in 1916, is caused by small Gram-negativecoccobacilli-shaped bacteria, Rickettsia prowazeki, that wasoriginally believed to be a virus because of its minute size and difficulty ofcultivation. Being an obligate intracellular parasite, it utilizes thecomponents within the cell to survive and multiply.

It was named in honor of H.T. Ricketts and L. von Prowazek, who in the course of their investigations diedof infection. The cell wall being excessively permeable to many largemetabolites accounts for the microorganism’s requirement for a living host. Thehost is believed to supply ATP, NAD, and CoA. (Brezina et al.

, 1973).Transmissionof Epidemic Typhus is through the body louse (Pediculus humanus corporis)faeces contaminated with R. prowazekii. Louse bite, causes itching andscratching , which allows the bacteria to enter the scratch or bite areathrough the skin.

Indirect transmission may occur if the lice infects oneperson, who then develops the disease and the then infected lice moves to thenext individual, infecting by bites and defaecation or directly, via sharedclothing between individuals.SIGNS AND SYMPTOMS: After an incubation period of 7-14 days, fever, headache, and prostration occursuddenly. Temperature shoots up to 40° C in several days, with slight morningremission, for nearly 2 weeks. Headache is intense. Small, pink macules, appearon the 4th to 6th day and rapidly cover the body, usually in the axillae and onthe upper trunk excluding the palms, soles, and face. Later, the rash becomesdark and maculopapular. the rash may become petechial and haemorrhagic, inextreme cases.

Splenomegaly occurs at times.EpidemicPropagation: Propagation is regulated in human populations by the circulationof lice between individuals. The louse is a comparatively an inefficientvector, due to short range of movement; it crawls and cannot fly. moreover, asthe active stages survive only for 7-10 days without a suitable host to feedon, accompanied by  the fact that theyare exclusively human parasites.

The epidemic spread is hence favoured by theexistence of a large louse population on humans who are crowded together intheir living quarters. Scratching and itching on the part of heavily infestedindividuals causes lice to move to the outer surface of clothing and be readilytransferred to others. Thus, in crowded tenements, jails, refugee camps, ortimes of war or disaster, when prisoners, refugees, or soldiers are unable tochange clothes or bath regularly, lice spreads quickly within the entirepopulation, especially during the winter, when bathing is made more difficultdue the chilled weather. Thus, in centuries andareas where overcrowding, malnourishment, and lack of sanitation wereprevalent, typhus spread rapidly. THEHISTORICAL IMPACT OF EPIDEMIC TYPHUS:TheFifteen Century: The firstrecord of epidemic typhus in history, was in 1489 during the Spanishinquisition and Reconquista. Louse-borne typhus epidemic broke out within theSpanish army killing over 17,000 soldiers within a month out of which only3,000 men had died in actual combat. Typhus, completely destructed the Spanisharmy allowing the Moors to maintain their stronghold in Granada.

TheSeventeenth Century: TheThirty Years War (1618-1648) was also impacted tremendously after itsintroduction to Typhus,  during the first15 years of the war. Along with Plague, typhus was responsible for the death of10,000,000 soldiers, compared to merely 350,000 men who died in combat and was alsoresponsible for preventing a battle between the armies of the Swedish KingGustavos Adolphus and the Catholic army commander Baron Von Wallenstein(1632).TheNineteenth Century: The 1812campaign of Napoleon Bonaparte, against the Russians, remains the classicexample. Napoleon’s Grand Armee, originally had over 600,000 tactful soldiers,marching their way with little resistance to take over Russian province.

Despite the warnings of his medical teams, he argued that his men couldwithstand the bitterest of Russian winters- which turned out to be a fatalmistake.  As the troops marched on, food and resources began todwindle, forcing soldiers to rampage the peasantry who were beset withdiseases. This resulted in Epidemic Typhus being brought into the camps alongwith the returning troops. The consequences were detrimental; more than80,000 French soldiers died within the first month of theepidemic. Weakening the morale of soldiers. Only 90,000 French soldiersreached Moscow out of the original army of 600,000.

  The majority, ashigh as 300,000, had died of Epidemic Typhus and dysentery, with combat lossesamounting to less than even 100,000. With this drastic loss and the Russianpolicy of Scorched Earth Plan, Napoleon was forced to retreat. World war I: The declaration of war by Austria againstSerbia in 1914 triggered by the assassination of Archduke Ferdinand quickly sparkedand led to an uncontrollable global conflict named World War I.On the Eastern Front, intense shelling ofSerbian cities destroyed the existing infrastructure , driving  the population to the streets. Minimum of20,000 Austrians were taken prisoner by the Serbs. There was a lack ofphysicians and other medical professionals, that overall, led to the rapidcollapse of the health status of defenceless populations. Malnutrition,overcrowding and a lack of hygiene paved the way for typhus.

In November 1914,typhus made its first occurance among refugees and prisoners, spreading rapidlyamong the troops. A year after the outbreak of hostilities, typhus killed150,000 people, of whom 50,000 were prisoners in Serbia. The mortality ratereached an epidemic peak of approximately 60 to 70% during this period. This desperatesituation discouraged the Germano-Austrian commandment from invading Serbia soas to prevent the spread of typhus within their borders.

Drastic measures weretaken, such as the quarantine of people with the first clinical signs of thedisease, along with attempts to apply standards of hygiene among the troops toprevent body lice infestations.On the Russian front, throughout the past twoyears of the turmoil and the Bolshevik revolution, approximately 2.5 milliondeaths were recorded. Typhus was latent in Russia long before the World War I.The mortality rate rose from 0.

13 per 1,000 in peacetime to 2.33 per 1,000 in1915. Typhus was imported and propagated throughout the country through thesoldiers and refugees. It was during the brutal winter of 1917–18, that thebiggest outbreak of typhus of modern history began in a Russia that was alreadydevastated by famine and war. The great epidemic started in the big cities leadingto the distant lands of the Urals, Siberia and Central Asia. At World War I,between 1919 and 1923, there were five million deaths in Russia and EasternEurope.WORLD WAR II: Henrique da Rocha Lima, a Brazilian doctor,discovered the cause of epidemic typhus in 1916 while doing research on typhusin Germany. nevertheless, still over 3 million succumbed to typhus during WorldWar I.

The discovery by Cox (1938) that R. prowazeki could be grown in the yolksac of developing chick embryos made it possible to prepare large amounts ofantigen for serological tests. In 1940 Cox and Bell prepared an Epidemic Typhusvaccine, consisting of a killed suspension of R. prowazeki grown on theyolk sac membrane of a chick, based upon the use of tissue culture. Thisvaccine Even though delousing station were set up and a typhus vaccine wasdeveloped before World War II, typhus epidemics continued to seek its victims,especially in German concentration camps during the Holocaust,where typhus was a major scourge (Anne Frank died in a camp at age 15 fromtyphus) and it will never be known how many inmates succumbed to the disease.Upon the liberation of Buchenwald, it was discovered that over 8,000 inmateswere suffering from typhus.

Major typhus outbreaks occurred throughout Germanyduring the course of the war. with statistics available in 1945 ,16,000 casesof typhus were revealed in that year. Japan also was afflicted by the scourgeof typhus during World War II, with approximately 45,000 cases.  The U.S. Army, which had been vaccinated fortyphus and had good amount of supplies of DDT available, set up many delousingstations throughout occupied areas in order to keep the disease within Germanyfrom spreading westward, proving to be largely successful. The historical roleplayed by Epidemic Typhus in World War II, therefore, due to the mass ofresearch on its prevention and control by Cox, Durand, and others, becamelargely a matter of introducing and refining methods for its control inmilitary and civilian populations so as to minimize its overall effects.

The threat of encountering typhus inboth the European and Mediterranean theaters was obviated by the compulsoryimmunization of all Allied personnel entering the area with the Cox vaccine.Typhus is now considered tobe endemic only in specific few areas of the world, including Eastern Africaand South and Central America. No vaccines are currently available to preventtyphus, but improved hygienic practices, improved insecticides, and antibioticshave made it easier to combat the disease and the vector that spread it. only a few epidemics (Africa, MiddleEast, Eastern Europe, and Asia) have occurred since then.

Because of toxicity,DDT has been banned in the U.S. since 1972.DIAGNOSIS:The diagnosis involves identification of the bacterial genus and species by PCRtesting of a skinbiopsy from skin rash or lesions, or bloodsamples. Immunohistological staining identifies the bacteria within infectedtissue (skin tissue, usually). Typhus can also be diagnosed, usually late orafter the disease has been treated with antibiotics, when significant titers ofanti-rickettsial antibodies are detected by immunological techniques.TREATMENT: Antibiotics are commonly used to treat thedisease including doxycycline,  the most preferred treatment.

Chloramphenicol, for those not pregnant or breastfeeding. ciprofloxacin is used for adults as asubstitute for doxycycline.CONCLUSION:After centuries of war when typhus played aleading role in the mortality, the disease has finally been suppressed.Itis therefore evident from this paper, that an inestimable amount of EuropeanHistory has been impacted by Man’s contact with the body louse and thepathogens it harbours. The untold misery that has been a major part and parcelof this interaction can never be estimated in its true sense, for historicalfacts and statistical data are rather pale shadows of the impact of typhus.Indeed, the spectacular advances of science have successfully relegated typhusto a pestilence of yesteryear.

however, the World Health Organization stilldescribes it as a “disease under surveillance”. The eradication ofpoverty, famine, and warfare are not only political, but medical concern aswell. Yet one cannot help but wonder if the truly salient feature of Man’sencounter with louse-borne typhus is not its effects on Man’s continualstruggle to overcome his enemies, but rather the opportunity afforded to thosein retrospect to feel the humility necessary for the survival of our species ina world of which we are, of necessity, but a small part.

   

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