Epidemic Typhus Research Articles

CONTRIBUTION TO THE UNDERSTANDING OF THE HEALTH SITUATION WITHIN THE POPULATION IN SLAVONIA AND SRIJEM DURING THE SECOND WORLD WAR WITH AN EMPHASIS ON INFECTIOUS DISEASES

During World War II, the population of agricultural areas of Slavonia and Srijem lived in privation, but there was no famine. A more serious threat was infectious diseases, such as malaria, typhoid fever, and dysentery, which were also present within the population in the post-war period. Major epidemics broke out mostly in areas under partisan control, especially in the areas of western and central Slavonia, where major epidemic typhus contagious broke out. Venereal diseases, less common in the Slavonian area before the war, were also on the rise. Two factors had an impact on the health situation within the population – state medical institutions and partisan medical corps. Health care and measures to combat infectious diseases were provided by state authorities, and that is still an insufficiently explored area in historiography. During the first years of the war, the partisan medical corps personnel, initially mostly semiskilled and lacking necessary medical equipment and medications, relied on the support from the population to a greater extent than they were able to provide medical care to them. With the arrival of professional staff and the acquisition of medicines and medical equipment, mainly sourced from medical institutions in areas under partisan control, they assumed a more active role in supporting civilian authorities under the “people’s rule”—specifically, the people’s liberation committees. Their focus shifted to healthcare for the civilian population, primarily aimed at suppressing and preventing infectious diseases. Further research on this topic will contribute to a more realistic perception of the civilian population’s everyday life during the war, which was presented in memoir literature and historiography of the socialist period as a heroic act of resistance rather than a struggle for survival in the conditions of privation and diseases; it will also complete the picture of the human losses of the civilian population caused by infectious diseases.

DDT Resistance Korean Body Lice and Development of Insecticide Resistance Knowledge during Korean War.

DDT exemplifies success and failure of modern science and technology. Once it was heralded as technological wonder that will deliver human from misery of insect-borne infectious disease. However DDT took dramatic downturn after failure in global malaria eradication program initiated by World Health Organization, with advent of DDT-resistant strain of mosquitoes. Although insecticide resistance has been know since late 19th century, the definitions and mythologies for finding resistance has not been settled until 1950s. This paper argues that discovery of DDT-resistant strain of body lice in prisoners of war camp in Korea during the Korean War provided essential knowledge and opportunity for advancing insecticide resistance studies. Since 1945 to the end of Korean War, US Army sprayed thousands of tonnes of DDT on Korean body and soil. DDT was only went into wide field application since 1943, was still a very new technology. The ways to deliver and utilize DDT was still under the investigation. And Korea, especially during the War, was ideal place to construct such knowledge and place it in the application. The main focus was to control public health threats, such as louse-borne typhus fever. Korean soldiers and prisoners of war exposed to regular dose of DDT, which soon gave rise to DDT-resistant strain of body lice. It was the first major outbreak of insecticide-resistance appeared in insect that has major public health importance. Until early 1950s, mechanisms of resistance, or even definition of insecticide resistance was unclear. Researchers in US Army and Department of Agriculture rushed to find the ways to quantify insecticide resistance. Network of laboratories, connecting Korea-Japan-US, had to devise new laboratory methods to rear, and test body lice. These body lice later migrate to laboratories in US, providing valuable asset for future insecticide resistance research in US. At the same time, laboratory methods of testing resistance in body louse became a standard across the globe, setting new research agenda through World Health Organization. This shows flow of knowledge, along with migration of body louse, during the Korean War. At the same time, this case show who new knowledge is constructed through the expense of involvement of minority populations, such as natives, soldiers, and prisoners of war.

Мотив болезни в романе Бориса Пастернака „Доктор Живаго”

The motif of illness and recovery lies at the core of the worldview of the protagonist of Boris Pasternak’s novel Doctor Zhivago. The novel refers to the motif of illness firstly because of the protagonist’s trade and the realities of the post-revolutionary and civil war years, which were accompanied (or followed) by typhus epidemics. Secondly, the motif of illness is inextricably linked with the time of major historic transitions, and as such with the prevalent feeling of violation of physical and psychological harmony of the universe. The article distinguishes and analyses a number of themes and motifs which are interwoven with the motif of illness, such as creativity, the release of unconscious impulses, liminal states, dreamstates, and the figure of the window. All these themes and motifs were outlined in Pasternak’s poems and later found their continuation and development in the novel Doctor Zhivago.

Colonial Fantasies, Imperial Realities: Race Science and the Making of Polishness on the Fringes of the German Empire, 1840–1920

Colonial Fantasies, Imperial Realities: Race Science and the Making of Polishness on the Fringes of the German Empire, 1840–1920

A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health.

The environmental conditions generated by war and characterized by poverty, undernutrition, stress, difficult access to safe water and food as well as lack of environmental and personal hygiene favor the spread of many infectious diseases. Epidemic typhus, plague, malaria, cholera, typhoid fever, hepatitis, tetanus, and smallpox have nearly constantly accompanied wars, frequently deeply conditioning the outcome of battles/wars more than weapons and military strategy. At the end of the nineteenth century, with the birth of bacteriology, military medical researchers in Germany, the United Kingdom, and France were active in discovering the etiological agents of some diseases and in developing preventive vaccines. Emil von Behring, Ronald Ross and Charles Laveran, who were or served as military physicians, won the first, the second, and the seventh Nobel Prize for Physiology or Medicine for discovering passive anti-diphtheria/tetanus immunotherapy and for identifying mosquito Anopheline as a malaria vector and plasmodium as its etiological agent, respectively. Meanwhile, Major Walter Reed in the United States of America discovered the mosquito vector of yellow fever, thus paving the way for its prevention by vector control. In this work, the military relevance of some vaccine-preventable and non-vaccine-preventable infectious diseases, as well as of biological weapons, and the military contributions to their control will be described. Currently, the civil–military medical collaboration is getting closer and becoming interdependent, from research and development for the prevention of infectious diseases to disasters and emergencies management, as recently demonstrated in Ebola and Zika outbreaks and the COVID-19 pandemic, even with the high biocontainment aeromedical evacuation, in a sort of global health diplomacy.

Involvement of Pore Formation and Osmotic Lysis in the Rapid Killing of Gamma Interferon-Pretreated C166 Endothelial Cells by Rickettsia prowazekii.

Rickettsia prowazekii, the bacterial cause of epidemic typhus in humans, proliferates mainly within the microvascular endothelial cells. Previous studies have shown that murine macrophage-like RAW264.7 cells are rapidly damaged if they are pretreated with gamma interferon (IFN-γ) and then infected with R. prowazekii. In the present study, the effects of IFN-γ and R. prowazekii on murine C166 endothelial cells were evaluated. In the IFN-γ-pretreated R. prowazekii-infected endothelial cell cultures, evidence of cell damage was observed within several hours after addition of the rickettsiae. Considerable numbers of the cells became permeable to trypan blue dye and ethidium bromide, and substantial amounts of lactate dehydrogenase (LDH) were released from the cells. Such evidence of cellular injury was not observed in the untreated infected cultures or in any of the mock-infected cultures. Polyethylene glycols (PEGs) of different nominal average molecular weights were used to assess the possible involvement of pore formation and osmotic lysis in this cellular injury. PEG 8000 dramatically suppressed LDH release, PEG 4000 partially inhibited it, and PEGs 2000 and 1450 had no effect. Despite its inhibition of LDH release, PEG 8000 did not prevent the staining of the IFN-γ-pretreated infected endothelial cells by ethidium bromide. These findings suggest that the observed cellular injury involves the formation of pores in the endothelial cell membranes, followed by osmotic lysis of the cells.

Don't Be a Nit Wit; Know Your Lousy Companions!

Lice have been a burden on humans since antiquity. The species implicated in human infestations, the head louse (Pediculus humanus capitis), body louse (Pediculus humanus humanus), and pubic louse (Pthirus pubis), are very well adapted to the human host and are readily transmissible between and among individuals. In addition to dermal reactions and social stigmas associated with louse infestations, the body lice are of additional medical and public health concern in the spreading of bacterial agents associated with louse-borne relapsing fever, epidemic typhus, and trench fever. In the United States, pthiriasis, caused by P. pubis, is classified as a sexually transmitted infection. In this review, we provide an update on the taxonomy, epidemiology, biology, evolution, clinical importance, treatment and control, diagnosis, and reporting of parasitic human lice.

СОСТОЯНИЕ МЕДИЦИНЫ В ТЮРЬМАХ ЕНИСЕЙСКОЙ ГУБЕРНИИ В КОНЦЕ XIX — НАЧАЛЕ ХХ ВВ.

It is established that the penitentiary system in the Yenisei province was organized rationally, financed from a position of economy, which was caused by the decisions of the central authorities. This concerned unsuccessful attempts to introduce single-cell prisons for prisoners, difficulties with guaranteeing the supply of drinking water through the well system. Due to the trinity of state, public and social elements of the penitentiary system, there are corresponding difficulties of a full-fledged analysis of one of the spheres, without affecting all the others in the process. Sources testify to the positive and negative aspects of medical care in the prisons of the Yenisei province in the second half of the XIX — early XX centuries. So, at that time, a medical professional assessment of the diets of prisoners and prisoners was already used, centralized control over their health was carried out. This information is confirmed by a number of identified medical documents on the organization and implementation of the nutrition process and the provision of prisons with sets of medical instruments for surgical interventions. The plans of hospital wards restored on the basis of archival documents and projects for their expansion allow us to judge the attempts to introduce reform ideas in connection with the liberal transformations of the system of the 1860s and 1870s, which were still not implemented in the Yenisei province due to insufficient funding. The documents raised from the State Archive of the Krasnoyarsk Territory and the State Archive of the Novosibirsk Region allow us to conclude that the main problem of hospitals at prison facilities was technical backwardness and time-related accident rate of buildings, there was a shortage of qualified personnel and housing for employees. At the same time, epidemics of typhus, cholera, smallpox in the prisons of the Yenisei province were not a frequent occurrence due to the responsible approach to the service of medical personnel.

Rickettsia Aglow: A Fluorescence Assay and Machine Learning Model to Identify Inhibitors of Intracellular Infection.

Rickettsia is a genus of Gram-negative bacteria that has for centuries caused large-scale morbidity and mortality. In recent years, the resurgence of rickettsial diseases as a major cause of pyrexias of unknown origin, bioterrorism concerns, vector movement, and concerns over drug resistance is driving a need to identify novel treatments for these obligate intracellular bacteria. Utilizing an uvGFP plasmid reporter, we developed a screen for identifying anti-rickettsial small molecule inhibitors using Rickettsia canadensis as a model organism. The screening data were utilized to train a Bayesian model to predict growth inhibition in this assay. This two-pronged methodology identified anti-rickettsial compounds, including duartin and JSF-3204 as highly specific, efficacious, and noncytotoxic compounds. Both molecules exhibited in vitro growth inhibition of R. prowazekii, the causative agent of epidemic typhus. These small molecules and the workflow, featuring a high-throughput phenotypic screen for growth inhibitors of intracellular Rickettsia spp. and machine learning models for the prediction of growth inhibition of an obligate intracellular Gram-negative bacterium, should prove useful in the search for new therapeutic strategies to treat infections from Rickettsia spp. and other obligate intracellular bacteria.

Vaktsyna Rudolfa Vaiglia u borotbi z vysypnym epidemichnym tyfom

Introduction. Vaccination has made a breakthrough in history by overcoming the infectious diseases that have plagued humanity for millennia. The twentieth century was marked by the invention of vaccines against epidemics typhus, which have become the only salvation in overcoming this disease. The history of the vaccine was developed on the example of the first effective vaccine against epidemic typhus, developed by a prominent Polish scientist, professor at the University of Lviv Rudolf Weigl, the history of vaccine development and the method of culturing R. Prowazekii in the intestine of Pediculus humanus corporis was studied. From Rickettsia Рrowazekii – the causative agent of epidemic typhus transmitted by aphids (Pediculus humanus corporis) in the history of mankind killed more people than in all known wars. Brazilian researcher Enrique da Rocha Lima differentiated described in detail and gave a specific name to the causative agent of typhus in 1916. In 1920, GW Epstein, as well as S. Burt Weilbach, John L. Todd and FW Palfrey in 1922 confirmed the etiological significance of R. Prowazekii in the presence of typhus. Biological and morphological characteristics, the life cycle of the pathogen and the impossibility of reproduction on artificial nutrient media were established. The aim of the study. According to the study of scientific sources to investigate the history of the technology of R. Weigl vaccine against epidemic typhus from its first series obtained in the laboratory and from 1930, when its production began, the period covering the 20-30s of the twentieth century. To establish that the scientific achievements of the scientists are not only the history of microbiology and virology, it is relevant today. Materials and methods. Content analysis, a method of systematic analysis of research on the typhus vaccine, was used. The implementation of scientific research began with a retrospective analysis of the scientific works of R. Weigl and his students. Selection of sources was carried out in the archives and scientific libraries of Lviv and the Research Institute of Epidemiology and Hygiene of Danylo Halytsky Lviv National Medical University, in scientometric databases PubMed, Medline, Web of Science, Google Scholar by keywords: lice, typhus, rubella, R. Prowazekii. 174 scientific works in English, Ukrainian, Polish, French and Russian were analyzed and sources were selected in which the issue of creating a vaccine against typhus, technology of its production, efficiency of application was covered. Results. The vaccine, developed by Professor Rudolf Weigl, author of the method of cultivating and accumulating the causative agent of this disease – R. Prowazekii in the intestine of the laboratory population of lice, despite the complexity of its preparation, for over 20 years was the only immunobiological drug to control typhus. Conclusions. We should be grateful to Rudolf Weigl and his students, who have often studied R. Рrowazekii at the cost of their lives and developed a vaccine against typhus, which has killed millions of people on our planet. Vaccination with a full dose of R. Weigl’s vaccine does not guarantee protection against infection, but reduces morbidity, completely eliminates mortality and facilitates the course of epidemic typhus.

Ends and Means: Typhus in Naples, 1943–1944

In 1943, Allied forces in recently liberated Naples were confronted with an outbreak of louse-borne typhus. The established Anglo-American narrative of that epidemic is a triumphant story of effective action that controlled the disease with unprecedented speed and success, aided by the pioneering use of the pesticide DDT. Rather than retell that tale, this article discusses why the outbreak and its ending are largely absent from Italian accounts of wartime Naples. Drawing on Italian sources and contemporary Allied ones, it argues that this absence speaks powerfully to the realities of life for Neapolitans at the time. These realities included the likelihood that the epidemic left most people unscathed, and the presence of additional challenges that made survival in the city perilous. Illustrating how tangled events (and even non-events) can be fashioned into simplistic but meaningful frameworks according to the perspective and priorities of the observer, the article also demonstrates how methods (in this case, delousing with insecticide) that were later proclaimed as crucial in ending an epidemic can be viewed very differently by populations required to comply with them, especially when the disease's dangers seem remote.

A biography of infectious diseases: Hans Zinsser and his Rats, Lice and History

Hans Zinsser, a well-known bacteriologist and immunologist in the United States in the early 20th century, made great advancement in the research of pathogen of typhus and its vaccine, with the epidemic typhus renamed after him. His masterpiece, Rats, Lice and History, teased out the co-evolutionary process of infectious diseases and their related organisms, focusing on specific cases and the development history of typhus. In this sense, he revealed the tremendous impact of infectious diseases on human history. He examined microorganisms and humans equally rather than simply from a human point of view. He analysed the pathological features of infectious diseases and provided professional insights into historical events of infectious diseases, such as the origin of syphilis and the plague of Athens, based on sufficient citations and references. He also advocated interpreting the history of infectious diseases with a holistic insight of history. His book, Rats, Lice and History, has been reprinted many times after its first publication, driving the following scholars to put the history of infectious diseases into a grand background of human development, enhancing the comprehension of ecology and politics and promoting the development of research in the history of diseases including life sciences, history and other disciplines.

Moonlighting in Rickettsiales: Expanding Virulence Landscape.

The order Rickettsiales includes species that cause a range of human diseases such as human granulocytic anaplasmosis (Anaplasma phagocytophilum), human monocytic ehrlichiosis (Ehrlichia chaffeensis), scrub typhus (Orientia tsutsugamushi), epidemic typhus (Rickettsia prowazekii), murine typhus (R. typhi), Mediterranean spotted fever (R. conorii), or Rocky Mountain spotted fever (R. rickettsii). These diseases are gaining a new momentum given their resurgence patterns and geographical expansion due to the overall rise in temperature and other human-induced pressure, thereby remaining a major public health concern. As obligate intracellular bacteria, Rickettsiales are characterized by their small genome sizes due to reductive evolution. Many pathogens employ moonlighting/multitasking proteins as virulence factors to interfere with multiple cellular processes, in different compartments, at different times during infection, augmenting their virulence. The utilization of this multitasking phenomenon by Rickettsiales as a strategy to maximize the use of their reduced protein repertoire is an emerging theme. Here, we provide an overview of the role of various moonlighting proteins in the pathogenicity of these species. Despite the challenges that lie ahead to determine the multiple potential faces of every single protein in Rickettsiales, the available examples anticipate this multifunctionality as an essential and intrinsic feature of these obligates and should be integrated into available moonlighting repositories.

Bovine petechial fever

This datasheet on bovine petechial fever covers Identity, Overview, Associated Diseases, Pests or Pathogens, Distribution, Hosts/Species Affected, Diagnosis, Pathology, Prevention/Control, Further Information.

THE CAUSES AND EXTENT OF THE FAMINE IN IRAN (1917–1919)

The article examines the problem of the famine that arose in Iran during the World War I in the fall of 1917 and ended in the spring of 1919. This issue practically was not explored by both Soviet and Russian researchers. The author argues that the main reasons for the outbreak of the disaster included not only drought and crop failures that had occurred two years before the start of the famine proper, but also the presence of foreign troops on the Iran soil, as well as the rise of wheat prices, introduced by the British military authorities in Iran, who were buying wheat for the needs of the British army, fighting in Mesopotamia, the desire of large local landowners to cash in on such supplies and their reluctance to sell grain to the Iranian government, which did not have the opportunity to buy it at the same prices as the English foragers and agents. Later, one of the largest landowners of the country Ahmed Shah was accused of wheat speculation. The paper pays particular attention to the number of famine victims, since foreign authors define them in tens of thousands, while some Iranian researchers — up to 10 million people. When assessing the consequences of the tragedy, the author tries to use indirect data from the post-war restoration of the Iranian economy sources, including the rapid growth in the production and export of handmade carpets. The latter would have been impossible with the death of half of the country’s population, since carpet weaving requires many workers. In addition, child labor was widely used in this industry, and children are the most vulnerable category of the population in such disasters as famine and epidemics. The author estimates the demographic losses of Iran in the period under review at 1–1.5 million people but believes that besides the famine the causes included epidemics of Spanish flu and typhus that raged in the country in those years.

EPIDEMICS IN KYIV COVERED IN THE NEWSPAPER PERIODICALS OF THE CITY OF THE LATE 19TH – EARLY 20TH CENTURIES

The article examines the coverage of the sanitary and epidemiological situation in the city in the late 19th – early 20th centuries in the Kyiv newspapers “Kievlyanin”, “Kievskie Vesti”, “Kievskaya Mysl”, “Yuzhnaya Kopeyka”. The processing of newspaper materials made it possible to identify problematic areas of work of the city authorities in the sanitary and communal spheres, namely inadequate control over observance of health standards in urban markets, failure to solve the problem of natural dumps and homeless people, illegal alcohol sales, lack of timely repair of roads, construction of water supply and sewerage. These factors were the main causes of epidemics of typhus, measles, tuberculosis, smallpox, cholera. Analysis of statistics on the pages of periodicals allows tracing the number of people affected by epidemics, identifying typical diseases for each district of the city, caused by their geographical location, population, location of facilities such as prisons, bazaars, cemeteries, hospitals.

Types of Rats and Their Parasites That Potential to Transmit Disease in Tugu District, Semarang City

Rats are known as vectors and reservoirs for various types of ecto and endoparasites. The existence of rats as cosmopolitan animals allows for complex parasitic transmission due to the relationship between humans, animals, and the environment. This study aimed to provide informative data on the types of rat along with their ecto- and endoparasites. This research is a qualitative descriptive study. Data collection was carried out by random sampling survey with a point time approach. Data collection was carried out in 4 villages, namely Tugurejo, Mangkang Wetan, Mangunharjo, and Mangkang Kulon Villages, Tugu District, Semarang City. A total of 89 rats were obtained, the species obtained were R. norvegicus, R. argentiventer, R. exulans, R. tiomanicus, R. surifer, R. tanezumi, B indica, and S. murinus. Ectoparasite infestation was found in all types of rats except S. murinus. The ectoparasites found were Xenopsylla cheopis and Laelaps echidninus which were reported as the main vectors of murine typhus, epidemic typhus, bartonellosis as well as scrub typhus and Q-fever disease. Endoparasite infestation was found in the intestinal organs, namely Diphyllobothrium sp. and two species of worm eggs Hymnoepis sp. and Trichuris trichiura which were reported as the cause of Diphyllobothriasis as well as digestion, absorption, which can result in the loss of protein, carbohydrates, fats, and blood in large quantities. Diphyllobothriasis is not transmitted from person to person, more than one family member can be infected by sharing common meals and having similar eating habits. This study can be used as an early warning for community against the potential of infectious diseases from rats as vectors in Tugu District, Semarang related to rats density, endoparasites and their ectoparasites.

Genetic Evidence of the Black Death in the Abbey of San Leonardo (Apulia Region, Italy): Tracing the Cause of Death in Two Individuals Buried with Coins.

The Abbey of San Leonardo in Siponto (Apulia, Southern Italy) was an important religious and medical center during the Middle Ages. It was a crossroads for pilgrims heading along the Via Francigena to the Sanctuary of Monte Sant’Angelo and for merchants passing through the harbor of Manfredonia. A recent excavation of Soprintendenza Archeologica della Puglia investigated a portion of the related cemetery, confirming its chronology to be between the end of the 13th and beginning of the 14th century. Two single graves preserved individuals accompanied by numerous coins dating back to the 14th century, hidden in clothes and in a bag tied to the waist. The human remains of the individuals were analyzed in the Laboratorio di Antropologia Fisica of Soprintendenza ABAP della città metropolitana di Bari. Three teeth from each individual were collected and sent to the Istituto Zooprofilattico Sperimentale di Puglia e Basilicata to study infectious diseases such as malaria, plague, tuberculosis, epidemic typhus and Maltese fever (Brucellosis), potentially related to the lack of inspection of the bodies during burial procedures. DNA extracted from six collected teeth and two additional unrelated human teeth (negative controls) were analyzed using PCR to verify the presence of human DNA (β-globulin) and of pathogens such as Plasmodium spp., Yersinia pestis, Mycobacterium spp., Rickettsia spp. and Brucella spp. The nucleotide sequence of the amplicon was determined to confirm the results. Human DNA was successfully amplified from all eight dental extracts and two different genes of Y. pestis were amplified and sequenced in 4 out of the 6 teeth. Molecular analyses ascertained that the individuals buried in San Leonardo were victims of the Black Death (1347–1353) and the data confirmed the lack of inspection of the corpses despite the presence of numerous coins. This study represents molecular evidence, for the first time, of Southern Italy’s involvement in the second wave of the plague pandemic.

A RARE CASE OF TYPHUS FEVER PRESENTING IN TEXAS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Typhus Fever is a rare bacterial infection (R. prowazekii and P. human capitis) commonly transmitted via louse vectors on humans. While rare in the US, there have been cases located east of the Mississippi River. We will describe a case of typhus fever in an elderly male located in Dallas, Texas. CASE PRESENTATION: A 73-year-old man with Parkinson Disease and hearing impairment developed acutely progressing weakness and encephalopathy. At baseline he was oriented to self and others and could ambulate with a walker. Now he was unable to ambulate, sit up in a chair and required a sitter due to disorientation. Initial labs were unremarkable save thrombocytopenia. He was admitted for progressing Parkinson vs infectious meningitis. The next day, he was less responsive and aphasic with a fever of 102.1F. An infectious work up and empiric antibiotics were started. By day 3, fever remained with negative cultures prompting an Infectious Disease consult. Head CT was unrevealing (cochlear implants precluded MRI). EEG revealed diffuse encephalopathy without epileptiform discharges. Lumbar puncture was deemed unsafe (thrombocytopenia). Repeat blood cultures, viral respiratory panel, COVID testing, strep pneumoniae, legionella and mycoplasma serologies, HIV, and a myriad of serologies for atypical sources of fever were drawn – all negative. Empiric treatment was broadened to include CNS dosing. On day 8, he required intubation for respiratory failure. Post platelet transfusion an LP was done, ultimately negative. On day 11, serologic Typhus Fever antibodies (IgM) resulted. At the time of diagnosis he had become ventilator dependent and prognosis was grim. Family withdrew life sustaining measures on day 13. DISCUSSION: Typhus fever occurs via louse feces which are highly infectious with Rickettsia and infect the host via injured skin or mucous membranes. Symptoms include fever, chills, headache, myalgia, fatigue, and rash. Neurologic manifestations include confusion, drowsiness, seizures, and coma. Diagnosis is made via serologic studies;immunofluorescent antibody tests or immunoblots. Treatment varies from days to weeks of doxycycline or chloramphenicol. Prognosis is dependent on patient demographics. Mortality is higher in males and increases with age. Prior to the development of antibiotics, prognosis was poor and mortality was high. With modern efficiency of testing and antibiotics, mortality has modestly improved (10-40%). CONCLUSIONS: While rare, Typhus fever is an important diagnosis to consider in patients presenting with encephalopathy regardless of location. Prognosis is fair in those promptly treated. Thus, high suspicion combined with early testing and empiric treatment is crucial for recovery. REFERENCE #1: Anderson, JO. Andersson, SG. A century of typhus, lice and Rickettsia. Research in Microbiology. 2000 Mar;151(2):143-50. REFERENCE #2: Houhamdi, L. Fournier, PE. Fang, R. Lepidi, H. Raoult, D. An experimental model of human body louse infection with Rickettsia prowazekii. J Infect Dis. 2002;186(11):1639. REFERENCE #3: Raoult, D. Roux, V. Ndihokubwayo, JB. Bise, G. Baudon, D. Marte, G. Birtles, R. Jail fever (epidemic typhus) outbreak in Burundi. Emerg Infect Dis. 1997;3(3):357. DISCLOSURES: No relevant relationships by christopher bettacchi, source=Web Response No relevant relationships by Adan (Adam) Mora, source=Web Response No relevant relationships by Ciara Wisecup, source=Web Response

The current state of the doctrine of the etiology of typhus

In connection with the modern European war, and also in view of the well-known fact of the extraordinary development of typhus epidemics in wartime, both in the ranks of active armies and among prisoners of war, in recent years among doctors there has been a significant increase in interest in the etiology of typhus. This interest, in addition, was largely fueled by those reports in the special literature that were made by a number of authors, and in particular Nicoll and his students, who published the results of their work and observations during the typhus epidemic in Tunisia.