Epidemic Typhus Research Articles

Sequencing of a New Target Genome: the <I>Pediculus humanus humanus</I> (Phthiraptera: Pediculidae) Genome Project

The human body louse, Pediculus humanus humanus (L.), and the human head louse, Pediculus humanus capitis, belong to the hemimetabolous order Phthiraptera. The body louse is the primary vector that transmits the bacterial agents of louse-borne relapsing fever, trench fever, and epidemic typhus. The genomes of the bacterial causative agents of several of these aforementioned diseases have been sequenced. Thus, determining the body louse genome will enhance studies of host-vector-pathogen interactions. Although not important as a major disease vector, head lice are of major social concern. Resistance to traditional pesticides used to control head and body lice have developed. It is imperative that new molecular targets be discovered for the development of novel compounds to control these insects. No complete genome sequence exists for a hemimetabolous insect species primarily because hemimetabolous insects often have large (2000 Mb) to very large (up to 16,300 Mb) genomes. Fortuitously, we determined that the human body louse has one of the smallest genome sizes known in insects, suggesting it may be a suitable choice as a minimal hemimetabolous genome in which many genes have been eliminated during its adaptation to human parasitism. Because many louse species infest birds and mammals, the body louse genome-sequencing project will facilitate studies of their comparative genomics. A 6-8X coverage of the body louse genome, plus sequenced expressed sequence tags, should provide the entomological, evolutionary biology, medical, and public health communities with useful genetic information.

Rudolf Carl Virchow

GENERALLY REGARDED AS one of the most brilliant and influential biomedical scientists of the 19th century, Rudolf Carl Virchow was, remarkably, also one of the most courageous and inspiring proponents of social medicine.1 He was born on October 13, 1821, in Schivelbein, Pomerania, then in eastern Prussia, but since 1945, part of northwestern Poland. Rebellious and intellectually gifted, in 1839 Virchow won a scholarship in 1839 to the Friedrich-Wilhelms Institut in Berlin, Germany, where he received his medical education.2 After obtaining his MD in 1843, he was appointed to an internship at Berlin’s Charite Hospital where he began his clinical career. He also initiated chemical and microscopic research, which led to his first publications and bold proclamations of the need for a drastic overhaul of medical research. In 1847, the 26-year-old Virchow co-founded a new journal, Archives for Pathological Anatomy and Physiology and Clinical Medicine (later Virchow’s Archives), which became a major force in the modernization of medical science. In 1849 he left Berlin for Wurzburg to accept Germany’s first chair in pathological anatomy. Soon after launching a comprehensive, 6-volume Handbook on Special Pathology and Therapeutics in 1854, Virchow returned to Berlin to head a new pathological institute and in 1858 published his classic Cellular Pathology. In the 1870s, while remaining a prolific biomedical scientist, Virchow also turned his attention increasingly to anthropology and archaeology. He died on September 5, 1902, much honored worldwide as one of the towering scientists of his era. Virchow’s career in social medicine was equally remarkable. His most famous contribution was his “Report on the Typhus Epidemic in Upper Silesia” excerpted here. The report originated when Virchow was asked by the Minister of Education to help investigate scandalous conditions in this poor rural area under Prussian control, with a large population of “ethnic Poles.” Although he studied many dimensions of the epidemic, his 190-page report is best remembered for its final 30 pages.3,4 Here Virchow applied ideas on the social causation of disease, derived from French and English sources, to conditions in Silesia and showed a close and sympathetic familiarity with Friedrich Engels’ stirring indictment, Condition of the Working Class in England (1844). Caught up in the heady atmosphere of his revolutionary times, Virchow enthusiastically endorsed what he proudly labeled “radical” political recommendations: introduction of Polish as an official language, democratic self-government, separation of church and state, and the creation of grassroots agricultural cooperatives. After returning to Berlin in March 1848 to participate in “revolutionary” political action on the streets, in July, Virchow helped found Medical Reform, a weekly newspaper that promoted the cause of social medicine under the banners “medicine is a social science” and “the physician is the natural attorney of the poor.” He continued until June 1849, when increasingly reactionary political pressures forced him to suspend publication. He became politically quiet in the early 1850s (as did many European radicals). When he returned to Berlin later in the decade, he again became active, although now in more moderate ways. In 1859 he was appointed to Berlin’s City Council, a position he held until his death, and there worked on sanitary and other public health reforms.5 In 1861 he helped found the German Progressive Party and was elected to the Prussian diet as a leader of the constitutional forces opposed to Otto von Bismarck. Virchow later continued that fight as a member of the German Reichstag from 1880 to 1893. Virchow’s dual career has been widely inspirational. He is often credited for being one of the first to make the case for the social origins of illness and the multifactorial etiology of epidemics.6,7 But beyond that he has also served as a powerful icon, hero, and role model because he was both a leading scientist and an insistent proponent of the social grounding of medicine, public health reform, and political engagement.8,9

Current Knowledge of Rickettsial Diseases in Italy

Rickettsial diseases continue to be the cause of serious health problems in Italy. From 1998 to 2002, 4,604 clinical cases were reported, with 33 deaths in the period from 1998 to 2001. Almost all the cases reported in Italy are cases of Mediterranean spotted fever (MSF). Other rickettsioses that have been historically documented are murine typhus and epidemic typhus. Since 1950, only sporadic cases of murine typhus have been reported, and Italy currently appears to be free of epidemic typhus. As in other European countries, imported cases of rickettsialpox, African tick-bite fever (ATBF), and scrub typhus have been reported. In 2004, three cases of a mild form of rickettsiosis were serologically attributed to Rickettsia helvetica.

Rickettsial Diseases in Russia

Currently, several rickettsioses are officially being reported in the Russian Federation. These are epidemic typhus and Brill-Zinsser disease, both caused by Rickettsia prowazekii which has a historic prevalence in Russia. Nowadays only single sporadic cases of R. prowazekii infection are reported. The last significant outbreak occurred in 1997 in a mental nursing home, where 29 cases were identified. Registered morbidity of typhus in Russia varies from 0 to 0.01 per thousand for the last decade. Siberian tick typhus, caused by R. sibirica, is registered on a large territory from Pacific coasts to Western Siberia, and its incidence continuously increases, varying between 2.5 and 4.0 thousand officially registered cases per year. Astrakhan spotted fever, caused by R. conorii subsp. caspia has been recognized since 1983. Recently, Far Eastern tick-borne rickettsiosis, caused by R. heilongjiangensis, has been described. Several other pathogenic spotted fever group rickettsiae have been detected and isolated from ticks in Russia; however, they have not yet been linked with clinical cases in these regions.

Arthropod‐Borne Diseases in Homeless

Homeless people are particularly exposed to ectoparasite. The living conditions and the crowded shelters provide ideal conditions for the spread of lice, fleas, ticks, and mites. Body lice have long been recognized as human parasites and although typically prevalent in rural communities in upland areas of countries close to the equator, it is now increasingly encountered in developed countries especially in homeless people or inner city economically deprived population. Fleas are widespread but are not adapted to a specific host and may occasionally bite humans. Most common fleas that parasite humans are the cat, the rat, and the human fleas, Ctenocephalides felis, Xenopsylla cheopis, and Pulex irritans, respectively. Ticks belonging to the family Ixodidae, in particular, the genera Dermacentor, Rhipicephalus, and Ixodes, are frequent parasites in humans. Sarcoptes scabiei var. hominis is a mite (Arachnida class) responsible for scabies. It is an obligate parasite of human skin. The hematophagic-biting mite, Liponyssoides sanguineus, is a mite of the rat, mouse, and other domestic rodents but can also bite humans. Finally, the incidence of skin disease secondary to infestation with the human bedbug, Cimex lectularius, has increased recently. Bacteria, such as Wolbacchia spp. have been detected in bedbug. The threat posed by the ectoparasite in homeless is not the ectoparasite themselves but the associated infectious diseases that they may transmit to humans. Except for scabies all these ectoparasites are potential vectors for infectious agents. Three louse-borne diseases are known at this time. Trench fever caused by Bartonella quintana (B. quintana), epidemic typhus caused by Rickettsia prowazekii, and relapsing fever caused by the spirochete Borrelia recurrentis. Fleas transmit plague (Xenopsylla cheopis and Pulex irritans), murine typhus (Xenopsylla cheopis), flea-borne spotted rickettsiosis on account of the recently described species Rickettsia felis (C. felis), and occasionally cat scratch disease on account of Bartonella henselae (C. felis). The role of fleas as potential vector of B. quintana has recently been suggested. Among the hematophagic-biting mites, L. sanguineus, is responsible for the transmission of Rickettsia akari, the etiologic agent of rickettsialpox. Virtually, no data are available on tick-borne disease in this population. This article will deal with epidemiology, diagnosis, prevention, and treatment of these ectoparasite and the infectious diseases they transmit to the homeless people.

Rickettsioses in Sub‐Saharan Africa

Although rickettsioses are among the oldest known vector-borne zoonoses, several species or subspecies of rickettsias have been identified in recent years as emerging pathogens throughout the world including in sub-Saharan Africa. To date, six tick-borne spotted fever group pathogenic rickettsias are known to occur in sub-Saharan Africa, including Rickettsia conorii conorii, the agent of Mediterranean spotted fever; R. conorii caspia, the agent of Astrakhan fever; R. africae, the agent of African tick-bite fever; R. aeschlimannii; R. sibirica mongolitimonae; and R. massiliae. On the other hand, fleas have long been known as vectors of the ubiquitous murine typhus, a typhus group rickettsiosis induced by R. typhi. However, a new spotted fever rickettsia, R. felis, has also been found to be associated with fleas, to be a human pathogen, and to be present in sub-Saharan Africa. Finally, R. prowazekii the agent of louse-borne epidemic typhus continues to strikes tens to hundreds of thousands of persons who live in Sub-Saharan with civil war, famine and poor conditions. We present an overview of these rickettsioses occurring in sub-Saharan Africa, focusing on the epidemiological aspects of emerging diseases.

Rickettsiosis in Europe

In Europe, rickettsioses are long-known infectious diseases. Until recently, it was thought that Mediterranean spotted fever due to Rickettsia conorii was the only tick-borne rickettsiosis in Europe. In the last decade new Rickettsia spp. have been implicated in human pathology (R. slovaca, R. sibirica mongolotimonae, R. helvetica). Furthermore, cases of infection due to flea-borne rickettsioses (R. typhi, R. felis) have been described. Finally, although no outbreak of epidemic typhus has been reported yet in central and southern Europe, we should be aware of the possibility of reemergence of this disease in Europe. Other rickettsioses exist that have not yet been implicated in human pathology. We should consider that climate changes and other factors could contribute to the emergence and reemergence of other new diseases.

Epidemiology of Rickettsioses in North Africa

The first description of Mediterranean spotted fever (MSF) was made by Conor and Brush in 1910 in Tunisia, where, at the same time, Nicolle described the role of lice in transmission of epidemic typhus. However, along this century, there have been few and fragmentary reports about ecology and epidemiology of rickettsioses in North Africa. This region was always considered, for these diseases, like other Mediterranean regions. The most human tick-borne rickettsiosis known to occur in North Africa is MSF caused by R. conorii and transmitted by the brown dog tick, Rhipicephalus sanguineus. Recent studies showed that other arthropode-transmitted rickettsiae are prevalent in North Africa: R. aeschlimannii, R. massiliae, and R. felis. Moreover, R. felis and R. aeschlimannii human infection were respectively confirmed, by serology in Tunisia, and by PCR in Morocco. The seroprevalence of R. conorii among healthy population was ranging from 5% to 8% in most of the countries. Epidemiological and clinical features are frequently resumed in an eruptive fever with eschar occurring in hot season in rural areas. Typhus group rickettsioses, caused by R. typhi and R. prowazekii are less frequently reported than in the 1970s. Seroprevalence of R. typhi among blood donors was from 0.5% to 4%. In Algeria about 2% of febrile patients had R. prowazekii antibodies. Moreover, reemerging threat of epidemic typhus should be considered, after the two cases recently diagnosed in the highlands of Algeria. Murine typhus, considered as "benign" typhus, is underestimated. When R. typhi was inserted in serologic tests, murine typhus became more frequently confirmed. In a recent study in Central Tunisia, we confirmed an emergence of murine typhus mistaken for R. conorii or viral infection. In addition to typhus surveillance, future studies have to determine which spotted fever group rickettsiae are prevalent in vectors and in human pathology.

Murine Typhus from Vietnam, Imported into Japan

To the Editor: In Vietnam, many febrile diseases such as malaria, dengue fever, Japanese encephalitis, scrub typhus, and more recently, severe acute respiratory syndrome (SARS) and avian influenza have been reported. Murine typhus cases were also reported during and before the 1960s but not thereafter (1–5). On May 3, 2003, a 54-year-old male resident of Tokushima, Japan, had onset of fever in the suburban town of Cu Chi, ≈60 km northwest of Ho Chi Minh City, Vietnam. Exanthema appeared on his trunk and limbs on May 7. He returned to Japan on May 9 and was admitted to Tokushima University Hospital on May 10. His body temperature was 39.0°C, and serum, C-reactive protein level was high (17.06 mg/dL) on admission (day 8 of illness). Unfortunately, the blood sample taken on that day was discarded. We then collected blood on days 10, 11, 12, 14, 17, and 24 of illness for diagnosis. Minocycline was administered on day 8 and resulted in a gradual decrease in fever and rash. Weil-Felix tests on day 12 showed the serum to be positive for Proteus vulgaris OX19 (titer 160); tests for P. vulgaris OX2 and OXK were negative (titer of 10 for both). We examined blood samples for possible diseases such as malaria, dengue fever, SARS, and rickettsioses. Giemsa-stained peripheral blood samples obtained on day 11 showed no malarial parasites. Results of immunoglobulin M (IgM)-capture ELISA of serum on days 10, 11, and 17 of illness were negative for dengue antibodies. Reverse transcription (RT)–PCR of the serum on day 11 was also negative. RT-PCRs of a pharyngeal swab and urine collected on day 11 were both negative for the SARS coronavirus. These specimens were also injected into Vero cells, and no cytopathic effects were generated. RT-PCR of these cultures was also negative for SARS coronavirus. Moreover, SARS antibodies were not found in serum samples on days 11 and 14 of illness. Serum was also tested for Orientia tsutsugamushi and Coxiella burnttii on day 12 to exclude scrub typhus and Q fever as diagnoses. Indirect immunofluorescence tests for etiologic agents of spotted fever, murine typhus, and epidemic typhus were then performed with serum samples collected on days 10, 14, and 24. We used Rickettsia typhi and R. prowazekii as typhus group (TG) rickettsial antigens and R. japonica and R. conorii as spotted fever group (SFG) rickettsiae. IgM antibody was detected for these antigens, indicating that the disease was a primary infection of rickettsiae (Table). When TG and SFG rickettsioses were compared, TG rickettsiae represented markedly higher elevated titers than SFG rickettsiae, which excluded a diagnosis of SFG rickettsiosis. PCR for the TG rickettsial genome in the convalescent-phase serum on day 10 was negative. Table IFA titers of the patient sera and the cross-absorption test* To demonstrate more detailed antigenic reactivity, Western immunoblotting was performed with serum on day 14 (6). The serum reacted similarly to the ladderlike lipopolysaccharide (LPS) of R. typhi and R. prowazekii. As expected from the group-specific nature of rickettsial LPS, no reaction was demonstrated to LPS of SFG rickettsiae, R. japonica and R. conorii, although weak reactivity, mainly to the major outer member protein of SFG rickettiae, rOmpB, and molecules of smaller sizes was shown (6,7). As described previously, rOmpB has cross-reactive antigenicity between TG and SFG rickettsiae (6). Compared with the trace reaction to rOmpB of SFG rickettsiae, an extremely high level of reaction was demonstrated to rOmpB of TG rickettsiae. These results confirmed the disease to be a TG rickettsiosis. To elucidate whether the disease was murine typhus or epidemic typhus, we conducted cross-absorption tests as described previously (8,9). Serum absorbed by R. typhi showed complete absorption, demonstrating no reaction to R. typhi or R. prowazekii (Table). However, the serum absorbed by R. prowazekii resulted in incomplete absorption, demonstrating no reactivity to R. prowazekii but some reactivity to R. typhi, which was left unabsorbed. Western immunoblotting with the serum absorbed by R. prowazekii showed reactivity only to the rOmpB of R. typhi but not to that of R. prowazekii. These results confirmed the diagnosis of murine typhus. This is the first serodiagnosis of murine typhus in Vietnam since the 1960s (1–5). Since rats inhabit the area where the patient acquired the illness, murine typhus seems to have occurred sporadically or endemically but to have been undiagnosed since the 1960s, maybe because it was thought to have been eradicated and thus widely forgotten. This case was the first imported into Japan since the 1940s, when many Japanese soldiers and residents who returned from abroad had the disease.

Tropical rickettsioses

In recent years, a bewildering array of emerging rickettsial pathogens have been described throughout the world, including in the tropics. Here we present an updated overview of scrub typhus, murine typhus, and epidemic typhus. We also present an update on the emerging spotted fever group rickettsioses described in the tropics through 2005, focusing on epidemiologic and clinical data and management.

Rickettsia prowazekiiand Real-time Polymerase Chain Reaction

Rickettsia prowazekii is the causative agent of epidemic typhus and a potential bioterrorism agent. Sensitive and specific rapid assays are needed to complement existing methods of detecting this organism. We developed a real-time quantitative polymerase chain reaction assay by using a species-specific probe targeting the gltA gene. This assay, which was rapid, specific for R. prowazekii only, and sensitive (cutoff detection of 1 to 5 copies per sample), detected and directly identified R. prowazekii in blood of 12 experimentally infected mice sampled at day 3 and 6 postinfection or in naturally or experimentally infected lice. Because our assay is highly standardized and easily adaptable, it could improve epidemic typhus surveillance in public health programs, especially for countries with underdiagnosed or unrecognized human cases.

Eradication of Typhus Exanthematicus in Bosnia and Herzegovina

Typhus exanthematicus in Bosnia and Herzegovina held in endemic areas from which especially quickly began spread after 1945. That year, in 1945, one hundred epidemics of typhus fever appeared, with the highest incidence rate in Europe of 215.04 per 1,000. Directions of unique program in the world were to eradicate lice of the body, but also establish monitoring of the recidivism, Brill-Zinsser disease. Since 1971, typhus exanthematicus (classical typhus) hasn't appeared in Bosnia and Herzegovina, so epidemic typhus can considered as an eradicated communicable disease.

Evidence for Louse‐Transmitted Diseases in Soldiers of Napoleon’s Grand Army in Vilnius

Many soldiers in Napoleon's Grand Army died of infectious diseases during its retreat from Russia. Because soldiers were commonly infested with body lice, it has been speculated that louse-borne infectious diseases, such as epidemic typhus (caused by Rickettsia prowazekii), were common. We investigated this possibility during recent excavations of a mass grave of Napoleon's soldiers in Vilnius, Lithuania. Segments of 5 body lice, identified morphologically and by polymerase chain reaction (PCR) amplification and sequencing, were found in earth from the grave that also contained fragments of soldiers' uniforms. DNA of Bartonella quintana (the agent of trench fever) was identified by PCR and sequencing in 3 of the lice. Similarly, PCR and sequencing of dental pulp from the remains of 35 soldiers revealed DNA of B. quintana in 7 soldiers and DNA of R. prowazekii in 3 other soldiers. Our results show that louse-borne infectious diseases affected nearly one-third of Napoleon's soldiers buried in Vilnius and indicate that these diseases might have been a major factor in the French retreat from Russia.

Characterization of RP 333, a gene encoding CapD of Rickettsia prowazekii with UDP-glucose 4-epimerase activity

The genetic mechanism of membrane assembly in Rickettsia prowazekii, the causative agent of epidemic typhus, is unknown. Recent progress in genomics of this small intracellular bacterium prompted us to explore membrane biogenesis as it pertains to identification and characterization of gene products that are of importance in polysaccharide biosynthesis. We chose to define the function of the R. prowazekii capD gene (RP 333) product designated as a putative epimerase. We detected a capD transcript in yolk sacs infected with R. prowazekii at ten days post-infection. The capD gene was PCR amplified and cloned into the entry vector pENTR/SD/D-TOPO and transferred to a low copy arabinose-inducible pBAD/ Myc-HisA expression plasmid constructed in our laboratory. The corresponding recombinant protein (CapD) was expressed in PL2, a galE28 mutant of Escherichia coli, and has been shown to epimerize UDP-galactose to UDP-glucose without the addition of NAD +. CapD characterization is important for defense strategies targeted towards design of an R. prowazekii vaccine, generation of new antibiotics, and opening the way for research in membrane biogenesis with respect to the parasitic lifestyle of Rickettsia.

Murderous medicine: Nazi doctors, human experimentation, and Typhus

In Murderous medicine Naomi Baumslag documents the complicity of Nazi doctors and pharmaceutical companies in murderous medical experiments related to epidemic typhus to further Jewish genocide. On the book’s cover is a picture of the shaved heads of newly dead men, frozen in snow, with snow caps as skull caps, reminiscent of the Jewish yarmulke. Eyes and mouths are closed, forever blinded and silenced about the conditions of their deaths. Perhaps only pictures can capture the essence of Nazi medical atrocities; but pictures also limit these atrocities, which are almost too numerous to catalog.

Multispacer Typing of Rickettsia prowazekii Enabling Epidemiological Studies of Epidemic Typhus

Currently, there is no tool for typing Rickettsia prowazekii, the causative agent of epidemic typhus, currently considered a potential bioterrorism agent, at the strain level. To test if the multispacer typing (MST) method could differentiate strains of R. prowazekii, we amplified and sequenced the 25 most variable intergenic spacers between the R. prowazekii and R. conorii genomes in five strains and 10 body louse amplicons of R. prowazekii from various geographic origins. Two intergenic spacers, i.e., rpmE/tRNA(fMet) and serS/virB4, were variable among tested R. prowazekii isolates and allowed identification of three and two genotypes, respectively. When the genotypes obtained from the two spacers were combined, we identified four different genotypes. MST demonstrated that several R. prowazekii strains circulated in human body lice during an outbreak of epidemic typhus in Burundi. This may help to discriminate between natural and intentional outbreaks. Our study supports the usefulness of MST as a versatile method for rickettsial strain genotyping.

Rickettsial diseases

<h2>Abstract</h2> Rickettsial diseases are transmitted by arthropod vectors and are responsible for various spotted and typhus fevers. Epidemic typhus fever (Rickettsia prowazekii) occurs in prisons, in refugee camps and during wars, when lice thrive in unhygienic, overcrowded conditions. Endemic typhus (R. typhi) arises when humans live close to flea-infested rodents, typically near granaries, breweries, shops and garbage tips. Spotted fever infections are contracted by humans in the rural habitat of the tick or mite vector and include Rocky Mountain (R. rickettsiae), Scrub typhus (Orientia tsutsugamushi), Mediterranean (R. conorrii) and African tick-bite (R. africae) fever. Spotted fevers are characterized by an eschar (black scab) at the site of the arthropod bite. A petechial or purpuric skin rash accompanies typhus and spotted fevers, though 10% of Rocky Mountain spotted fever and almost all cases of African tick-bite fever are ‘spotless'. Other features are headache, night sweats, lymphadenopathy and conjunctivitis. Vasculitic complications include gangrenous extremities, bowel perforation, liver dysfunction, renal failure, meningoencephalitis, disseminated intravascular coagulation and pneumonia. Laboratory diagnosis is by demonstration of seroconversion on paired samples using immunofluorescence assay. Tetracyclines are the mainstay of treatment. Children, pregnant women and those allergic to tetracyclines can be treated with chloramphenicol or newer macrolides. There are currently no vaccines against rickettsial diseases. Avoidance of the insect vector using protective clothing and topical repellents is recommended. Mortality may approach 10–25% in epidemic typhus and scrub typhus, but is lower (2–5%) in Mediterranean spotted fever and murine typhus.

A Lost Chapter in the Early History of DDT: The Development of Anti-Typhus Technologies by the Rockefeller Foundation's Louse Laboratory, 1942-1944

On 5 December 1943, General Dwight D. Eisenhower, commander of the Allied forces in North Africa and Italy, sent an urgent secret radiogram to Washington regarding the War Department's refusal to ship to North Africa a large quantity of a secret new chemical for the control of louse-borne typhus. Arguing that typhus fever is [an] actual threat to military personnel in Italy at this time, he stated that seventeen tons of [DDT] concentrate are total requirements for this theater for Civil and Military [authorities]. Then he demanded reconsideration of [Washington's] decision to deny shipment of equivalent 10 tons concentrate and that [instead the] shipment be made on highest priority, and emphasized the seriousness of the situation by reminding his superiors that the season of [typhus] prevalence commences early in January. Impressed by its commanding general's argument, the department immediately reversed its position, and speeded shipments of the precious DDT for use in the Mediterranean. DDT's astounding effectiveness led Eisenhower to send another secret message a month later, insisting that it is considered of utmost importance that additional five tons DDT 100% be made available for A [Hied] Military] G[overment] use. This must reach this theater in late February without fail. l Unknown as an insecticide

AUTOCHTHONOUS EPIDEMIC TYPHUS ASSOCIATED WITH BARTONELLA QUINTANA BACTEREMIA IN A HOMELESS PERSON

Trench fever, a louse-borne disease caused by Bartonella quintana, is reemerging in homeless persons. Epidemic typhus is another life-threatening louse-borne disease caused by Rickettsia prowazekii and known to occur in conditions of war, famine, refugee camps, cold weather, poverty, or lapses in public health. We report the first case of seroconversion to R. prowazekii in a homeless person of Marseilles, France. This was associated with B. quintana bacteremia. Although no outbreaks of typhus have been notified yet in the homeless population, this disease is likely to reemerge in such situation.

Excretion of LivingBorrelia recurrentisin Feces of Infected Human Body Lice

Louse-borne relapsing fever (LBRF), caused by Borrelia recurrentis, is 1 of the most dangerous arthropod-borne diseases. Infection is thought to occur through louse crushing. Lice feces have not been shown to contain living borreliae. We infected 800 body lice by feeding them on a rabbit made spirochetemic by the injection of 2 x 106 borreliae. The life span of infected lice was not shortened. Once infected, lice remained infected for life but did not transmit borreliae to their progeny or to nurse rabbits. B. recurrentis infection was observed throughout lice and spread into hemolymph on day 5 after infection. We describe 2 unprecedented phenomena. In hemolymph, B. recurrentis formed clumps of aggregated borreliae. Using immunofluorescence assay, transmission electron microscopy, and culture, we detected borreliae excreted in lice feces beginning on day 14 after infection. We conclude that, similar to epidemic typhus and trench fever, transmission of LBRF may be caused by lice feces.