THEHISTORICAL ACCOUNT OF EPIDEMIC TYPHUSINTRODUCTIONLouseborne typhus is one of the oldest pernicious diseases ,that has been hauntingmankind since ages. Known by the many names such as “camp fever”, “war fever”,”jail fever” and “tabarillo” and confused with many other fevers and diseases,it was only in the late 15th century, it was identified as a causeof major epidemics. With Plague, Typhoid, and Dysentery, it is known to have wipedout armies and civilian populations from the 15th to the 20th century, playinga decisive role in the fate of wars in Europe. This paper will attempt tofurther analyse the historical impact of Louse-borne Typhus and how itsepidemic propagation has led many to regard Pediculus humanus corporis tohave a more remarkable influence on human history than any other 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. 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 prowazekii, 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 honour ofH. T. Ricketts and L. von Prowazek, who in the course of their investigationsdied of 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 area throughthe skin. Indirect transmission may occur if the lice infects one person, whothen develops the disease and the then infected lice moves to the nextindividual, infecting by bites and defaecation or directly, via shared clothingbetween individuals.SIGNS AND SYMPTOMS: After an incubation period of 7-14 days, fever, headache, and prostrationoccur suddenly. Temperature shoots up to 40° C in several days, withslight morning remission, for nearly 2 weeks. Headache is intense. Small, pinkmacules, appear on the 4th to 6th day and rapidly cover the body, usually inthe axillae and on the upper trunk excluding the palms, soles, and face. Later,the rash becomes dark and maculopapular.
The rash may become petechial and haemorrhagic,in extreme cases. Splenomegaly occurs at times.EpidemicPropagation: Propagation is regulated in human populationsby the circulation of lice between individuals.
The louse is a comparatively aninefficient vector, due to short range of movement; it crawls and cannot fly. Moreover,the active stages survive only for 7-10 days without a suitable host to feedon, accompanied by the fact that they are exclusively human parasites. Theepidemic spread is hence favoured by the existence of a large louse populationon humans who are crowded together in their living quarters.
Scratching anditching on the part of heavily infested individuals causes lice to move to theouter surface of clothing and be readily transferred to others. Thus, incrowded tenements, jails, refugee camps, or times of war or disaster, whenprisoners, refugees, or soldiers are unable to change clothes or bathregularly, lice spreads quickly within the entire population, especially duringthe winter, when bathing is made more difficult due the chilled weather. Thus, in centuries and areas where overcrowding,malnourishment, and lack of sanitation were prevalent, 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.
TheSeventeenth Century: in theThirty Years War (1618-1648), the first 15 years, was also impacted tremendouslyafter its introduction to Typhus. Along with Plague, typhus was responsible forthe death of 10,000,000 soldiers, compared to merely 350,000 men who died incombat. (1632).TheNineteenth Century: The 1812 campaign of Napoleon Bonaparte, against theRussians, remains the classic example.
Napoleon’s Grand Armee, originally hadover 600,000 tactful soldiers, marching their way with little resistance totake over Russian province. France andRussia had been tense allies. In 1812, His army entered Russiancontrolled Poland. Poland is where things took a turn for Napoleon. Theterritory was filthy beyond belief. The peasants were unwashed, with mattedhair and infested with lice and fleas, and the wells were fouled. Beingin an enemy state, the resources soon began to dwindle and it became difficultto provide food and water to the soldiers.
The army was too huge to keep itsmilitary formation intact, and the greater part of the army dissolved intostraggling and sprawling mobs. The soldiers, therefore raided the livestock,fields and houses of the local farmers that were full of parasite. The typical warintestinal diseases such as dysentery began to appear, and although newhospitals were set up, they were unable to deal with the innumerable sicksoldiers.
Few days after crossing the Nieman, many soldiers startedto develop high fever and red rashes on their bodies. Some developed a bluishtinge on faces and died. Typhus had made its appearance.Typhus, had been present in Poland and Russia since manyyears, but it had worsened since the Russian army had ruined Poland whileretreating from Napoleon’s army. Absence of cleanliness along with the unexpectedlyheated summer provided a perfect environment for the infestation and spread oflice. It was an entire century after the 1812 campaign, before the scientistsdiscovered that typhus is spread through lice excreta.The French soldiers were sweaty, unclean and lived in thesame clothes for days; providing the suitable environment for louse to feed andfind inhabit in his clothing.
Once the skin and clothes of the soldier wascontaminated with louse excreta, the smallest abrasion or scratch was enoughfor the germ to enter the soldier’s body. To magnify the problem, the soldierswere sleeping in large groups in confined spaces, for safety. This closenessenabled the lice to get transmitted easily. Within a month into the campaign,Napoleon lost 80,000 soldiers who were either had died from typhus or wereincapacitated. Soldierssuffering from typhus, lying in the streets.
On July 28, Napoleon’s officers expressed concerns withhim that the battle with the Russians was becoming fatal. The loss of comradesto desertion and disease was inestimable. In addition to which, there was aproblem of finding provisions in hostile territory, he however argued that his men could withstand thebitterest of Russian winters- which turned out to be his biggest mistake. Napoleon and his sick, weary soldiers marched on.
TheRussians retreated as the French advanced, drawing Napoleon deeper into Russianterritory. By Aug. 25, Napoleon had lost 105,000 of his main army of 265,000,leaving only 160,000 soldiers. Within two weeks, typhus had decreased the armyto 103,000.On Sept. 7, French forces engaged the Russians resultingin heavy casualties.
Napoleon then marched onto Moscow with only 90,000soldiers. He had expected the Russians to surrender; however, the citizenssimply left Moscow to Napoleon after burning three-fourth of it leaving no foodor provisions. Fifteen thousand reinforcements joined Napoleon in Moscow, butof those, 10,000 died of typhus. With the Russian winter rapidly approaching,Napoleon had no choice but to retreat. Worldwar I: During World War I, minimum of20,000 Austrians were taken prisoner by the Serbs. There was lack of medicalprofessionals, that led to the rapid collapse of the health status of unawarepopulation.
Lack of hygiene, malnutrition and overcrowding paved the way fortyphus. In November 1914, typhus made its first appearance among prisoners andrefugees, spreading quickly among the troops. A year later, typhus had killed150,000 people, of whom 50,000 were prisoners in Serbia. The mortality rate hadreached an epidemic peak of 60 to 70%.
Drastic measures, such as attempts toapply standards of hygiene among the troops to prevent body lice infestationsand the quarantine of people with the first clinical signs of the disease, weretaken, along.In Russia, over past two years of the turmoiland the Bolshevik revolution, approximately 2.5 million deaths were recorded.Typhus was latent in Russia long before the World War I. The mortality raterose from 0.
13 per 1,000 in peacetime to 2.33 per 1,000 in 1915. Typhus wasimported and propagated throughout the country through the soldiers andrefugees. During the brutal winter of 1917–18, the biggest outbreak of typhus ofmodern history began in a Russia that was already devastated by famine and warresulting in five million deaths in Russia and Eastern Europe.WORLD WAR II: Henrique da Rocha Lima, a Brazilian doctor,discovered the cause of epidemic typhus in 1916 while doing research in Germany.The discovery by Cox (1938) that R.
prowazekii could be grown in the yolk sac of developing chickembryos made it possible to prepare an Epidemic Typhus vaccine, consisting of akilled suspension of R. prowazekii grown in chick embryo. Even thoughdelousing station were set up and a typhus vaccine was developed, typhusepidemics continued to seek its victims, especially in German concentration camps during the Holocaust, where typhuswas a major scourge (Anne Frank died in a camp at age 15 from typhus) and itwill never be known how many inmates succumbed to the disease. Upon theliberation of Buchenwald, it was discovered that over 8,000 inmates weresuffering from typhus. Major typhus outbreaks occurred throughout Germanyduring the course of the war.
With statistical data available in 1945 16,000cases of typhus were revealed in that year. Japan, also was afflicted by thescourge of typhus during World War II, with approximately 45,000 cases. TheU.S. Army, which had been vaccinated for typhus and had good amount of suppliesof DDT available, set up many delousing to keep the disease from spreading, thatproved to be largely successful. The historical role played by Epidemic Typhusin World War II, therefore, due to the mass of research on its prevention andcontrol by Cox, Durand, and others, became largely a matter of introducing andrefining methods for its control in military and civilian populations so as tominimize its impact. 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 (Cox vaccine was ineffective), but improved hygienic practices, improvedinsecticides, and antibiotics have made it easier to combat the disease and thevector that spread it.
Onlya few epidemics (Africa, Middle East, Eastern Europe, and Asia) have occurredsince then. Because of toxicity, DDT has been banned in the U.S. since 1972.DIAGNOSIS: The diagnosis involves identification of thebacterial genus and species by PCR testing of a skinbiopsy fromskin rash or lesions, or blood samples.
Immunohistological staining identifiesthe bacteria within infected tissue (skin tissue, usually). Typhus can also bediagnosed, usually late or after the disease has been treated with antibiotics,when significant titers of anti-rickettsial antibodies are detected byimmunological 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 History hasbeen impacted by Man’s contact with the body louse and the pathogens itharbours that can never be estimated in its true sense, for historical factsand statistical data are rather pale shadows of the impact of typhus. Indeed,the spectacular advances of science have successfully relegated typhus to apestilence of yesteryear.
However, the World Health Organization stilldescribes it as a “disease under surveillance”. The eradication ofpoverty, famine, and warfare are a priority. Yet one cannot help but wonder ifthe truly salient feature of Man’s encounter with louse-borne typhus is not itseffects on Man’s continual struggle to overcome his enemies, but rather theopportunity afforded to those in retrospect to feel the humility necessary forthe survival of our species in a world of which we are, of necessity, but asmall part.