THE other fevers and diseases, it was only in

THE
HISTORICAL ACCOUNT OF EPIDEMIC TYPHUS

INTRODUCTION

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Louse
borne typhus is one of the oldest pernicious diseases, that has been haunting
mankind. 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 cause of major
epidemics. With Plague, Typhoid, and Dysentery, it is known to have wiped out armies
and civilian populations from the 15th to the 20th century, playing a decisive
role in the fate of wars in Europe. This paper will attempt to further analyse  the historical impact of Louse-borne Typhus
and how its epidemic propagation has led many to regard Pediculus humanus
corporis to have a more remarkable influence on human history than any
other parasite.

EPIDEMIC
TYPHUS FEVER (TABARILLO, CLASSIC OR EUROPEAN TYPHUS, JAIL FEVER, WAR FEVER)

The
denomination “typhus” was derived from the Greek word typhos, meaning
“smoke” resembling the delirious
state, that one suffers from, during infection. Originally,
“typhus” represented any of the self-limiting fevers accompanied by
stupor. In 1829, the French clinician Louis demarcated ‘Typhus Fever’ from
‘Typhoid Fever’.

Causative
Agent and transmission : Epidemic Typhus, as isolated and
identified by DaRocha-Lima in 1916, is caused by small Gram-negative
coccobacilli-shaped bacteria, Rickettsia prowazeki, that was
originally believed to be a virus because of its minute size and difficulty of
cultivation. Being an obligate intracellular parasite, it utilizes the
components 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 died
of infection. The cell wall being excessively permeable to many large
metabolites accounts for the microorganism’s requirement for a living host. The
host is believed to supply ATP, NAD, and CoA. (Brezina et al., 1973).

Transmission
of Epidemic Typhus is through the body louse (Pediculus humanus corporis)
faeces contaminated with R. prowazekii. Louse bite, causes itching and
scratching , which allows the bacteria to enter the scratch or bite area
through the skin. Indirect transmission may occur if the lice infects one
person, who then develops the disease and the then infected lice moves to the
next individual, infecting by bites and defaecation or directly, via shared
clothing between individuals.

SIGNS AND SYMPTOMS: After an incubation period of 7-14 days, fever, headache, and prostration occur
suddenly. Temperature shoots up to 40° C in several days, with slight morning
remission, for nearly 2 weeks. Headache is intense. Small, pink macules, appear
on the 4th to 6th day and rapidly cover the body, usually in the 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.

Epidemic
Propagation: Propagation is regulated in human populations by the circulation
of lice between individuals. The louse is a comparatively an inefficient
vector, due to short range of movement; it crawls and cannot fly. moreover, as
the active stages survive only for 7-10 days without a suitable host to feed
on, accompanied by  the fact that they
are exclusively human parasites. The epidemic spread is hence favoured by the
existence of a large louse population on humans who are crowded together in
their living quarters. Scratching and itching on the part of heavily infested
individuals causes lice to move to the outer surface of clothing and be readily
transferred to others. Thus, in crowded tenements, jails, refugee camps, or
times of war or disaster, when prisoners, refugees, or soldiers are unable to
change clothes or bath regularly, lice spreads quickly within the entire
population, especially during the 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.

 

THE
HISTORICAL IMPACT OF EPIDEMIC TYPHUS:

The
Fifteen Century: The first
record of epidemic typhus in history, was in 1489 during the Spanish
inquisition and Reconquista. Louse-borne typhus epidemic broke out within the
Spanish army killing over 17,000 soldiers within a month out of which only
3,000 men had died in actual combat. Typhus, completely destructed the Spanish
army allowing the Moors to maintain their stronghold in Granada.

The
Seventeenth Century: The
Thirty Years War (1618-1648) was also impacted tremendously after its
introduction to Typhus,  during the first
15 years of the war. Along with Plague, typhus was responsible for the death of
10,000,000 soldiers, compared to merely 350,000 men who died in combat and was also
responsible for preventing a battle between the armies of the Swedish King
Gustavos Adolphus and the Catholic army commander Baron Von Wallenstein(1632).

The
Nineteenth Century: The 1812
campaign of Napoleon Bonaparte, against the Russians, remains the classic
example. 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 could
withstand the bitterest of Russian winters- which turned out to be a fatal
mistake.  As the troops marched on, food and resources began to
dwindle, forcing soldiers to rampage the peasantry who were beset with
diseases. This resulted in Epidemic Typhus being brought into the camps along
with the returning troops. The consequences were detrimental; more than
80,000 French soldiers died within the first month of the
epidemic. Weakening the morale of soldiers. Only 90,000 French soldiers
reached Moscow out of the original army of 600,000.  The majority, as
high as 300,000, had died of Epidemic Typhus and dysentery, with combat losses
amounting to less than even 100,000. With this drastic loss and the Russian
policy of Scorched Earth Plan, Napoleon was forced to retreat.

 

World war I: The declaration of war by Austria against
Serbia in 1914 triggered by the assassination of Archduke Ferdinand quickly sparked
and led to an uncontrollable global conflict named World War I.

On the Eastern Front, intense shelling of
Serbian cities destroyed the existing infrastructure , driving  the population to the streets. Minimum of
20,000 Austrians were taken prisoner by the Serbs. There was a lack of
physicians and other medical professionals, that overall, led to the rapid
collapse 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 rapidly
among the troops. A year after the outbreak of hostilities, typhus killed
150,000 people, of whom 50,000 were prisoners in Serbia. The mortality rate
reached an epidemic peak of approximately 60 to 70% during this period. This desperate
situation discouraged the Germano-Austrian commandment from invading Serbia so
as to prevent the spread of typhus within their borders. Drastic measures were
taken, such as the quarantine of people with the first clinical signs of the
disease, along with attempts to apply standards of hygiene among the troops to
prevent body lice infestations.

On the Russian front, throughout the past two
years of the turmoil and the Bolshevik revolution, approximately 2.5 million
deaths 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 in
1915. Typhus was imported and propagated throughout the country through the
soldiers and refugees. It was during the brutal winter of 1917–18, that the
biggest outbreak of typhus of modern history began in a Russia that was already
devastated by famine and war. The great epidemic started in the big cities leading
to 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 Eastern
Europe.

WORLD WAR II: Henrique da Rocha Lima, a Brazilian doctor,
discovered the cause of epidemic typhus in 1916 while doing research on typhus
in Germany. nevertheless, still over 3 million succumbed to typhus during World
War I. The discovery by Cox (1938) that R. prowazeki could be grown in the yolk
sac of developing chick embryos made it possible to prepare large amounts of
antigen for serological tests. In 1940 Cox and Bell prepared an Epidemic Typhus
vaccine, consisting of a killed suspension of R. prowazeki grown on the
yolk sac membrane of a chick, based upon the use of tissue culture. This
vaccine Even though delousing station were set up and a typhus vaccine was
developed 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 from
typhus) 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 inmates
were suffering from typhus. Major typhus outbreaks occurred throughout Germany
during the course of the war. with statistics available in 1945 ,16,000 cases
of typhus were revealed in that year. Japan also was afflicted by the scourge
of typhus during World War II, with approximately 45,000 cases.  The U.S. Army, which had been vaccinated for
typhus and had good amount of supplies of DDT available, set up many delousing
stations throughout occupied areas in order to keep the disease within Germany
from spreading westward, proving to be largely successful. The historical role
played by Epidemic Typhus in World War II, therefore, due to the mass of
research on its prevention and control by Cox, Durand, and others, became
largely a matter of introducing and refining methods for its control in
military and civilian populations so as to minimize its overall effects. The threat of encountering typhus in
both the European and Mediterranean theaters was obviated by the compulsory
immunization of all Allied personnel entering the area with the Cox vaccine.

Typhus is now considered to
be endemic only in specific few areas of the world, including Eastern Africa
and South and Central America. No vaccines are currently available to prevent
typhus, but improved hygienic practices, improved insecticides, and antibiotics
have made it easier to combat the disease and the vector that spread it. only a few epidemics (Africa, Middle
East, 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 PCR
testing of a skin
biopsy from skin rash or lesions, or blood
samples. Immunohistological staining identifies the bacteria within infected
tissue (skin tissue, usually). Typhus can also be diagnosed, usually late or
after the disease has been treated with antibiotics, when significant titers of
anti-rickettsial antibodies are detected by immunological techniques.

TREATMENT: Antibiotics are commonly used to treat the
disease including doxycycline,  the most preferred treatment. Chloramphenicol
, for those not pregnant or breastfeeding. ciprofloxacin is used for adults as a
substitute for doxycycline.

CONCLUSION:
After centuries of war when typhus played a
leading role in the mortality, the disease has finally been suppressed.It
is therefore evident from this paper, that an inestimable amount of European
History has been impacted by Man’s contact with the body louse and the
pathogens it harbours. The untold misery that has been a major part and parcel
of this interaction can never be estimated in its true sense, for historical
facts and statistical data are rather pale shadows of the impact of typhus.
Indeed, the spectacular advances of science have successfully relegated typhus
to a pestilence of yesteryear. however, the World Health Organization still
describes it as a “disease under surveillance”. The eradication of
poverty, famine, and warfare are not only political, but medical concern as
well. Yet one cannot help but wonder if the truly salient feature of Man’s
encounter with louse-borne typhus is not its effects on Man’s continual
struggle to overcome his enemies, but rather the opportunity afforded to those
in retrospect to feel the humility necessary for the survival of our species in
a world of which we are, of necessity, but a small part.