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Medical File No. 005

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Name of disease: : Louse-borne typhus fever Name of disease: Typhus Exanthematicus

Cause and Louse-borne typhus fever is an epidemic disease that usually strikes populations
transmission living under extreme conditions. These conditions include extensive overcrowding
with poor personal and environmental sanitation, such as in refugee camps, prisons,
and military camps. Under such conditions, the parasite that causes the disease,
Rickettsia prowazekii, is transmitted to people through the bite of body lice (Pediculus
humanus corporis). After a louse bites an infected human, it ingests the rickettsiae in
the blood, which then multiply in the louse’s digestive system and are deposited in
the next human it bites. The rickettsiae enter the human circulatory system when the
bite is scratched.

Symptoms The incubation period after the bite extends from one to two weeks. The disease
and typically presents with severe headaches, fever as high as 40 degrees centigrade,
progression cough, and severe and diffused muscle pain. On the fifth day a spotty rash
appears, beginning gradually on the upper body. The rash does not cover the face.
Neurological symptoms are common, along with confusion and a hazy state of
consciousness. The rampant stage of the disease usually lasts from 10 days to three
weeks. The mortality rate among untreated patients can be as high as 40%, with
death caused by massive organ failure.

Treatment The approach to the treatment of louse-borne typhus fever is first and foremost
and preventive – maintenance of personal hygiene to prevent body lice. Infected persons
medications are easily treated with specific antibiotics.

Notes No descriptions of louse-borne typhus fever sufferers can be found in medical literature
in antiquity or even in the Middle Ages, nor can references to epidemics resulting from
a disease of this type. Because the clinical presentation of louse-borne typhus fever
is very typical, and ancient physicians would have been unlikely to miss it, it may be
assumed that the disease did not exist in antiquity or medieval times.
The first time a louse-borne typhus fever epidemic was noted was among soldiers
of the Spanish army during the siege on the city of Granada in 1491. The clinical
description of the symptoms is typical and underscores the likelihood that the disease
was not previously known. From then on, louse-borne typhus fever became a regular
visitor to the camps of the various armies that fought on European soil. Most of the
mortality during the Thirty Years’ War (1618–1648) and Napoleon’s campaign to Russia
(1812) stemmed from louse-borne typhus fever. The disease reappeared among troops
in World War I and World War II. The wars in the Horn of Africa in the 1990s, in which
various populations were forced to flee their homes and became refugees, saw major
outbreaks of louse-borne typhus fever. In 1997 alone, in Burundi, more than 100,000
people were struck with the disease and mortality was high.

Name of Prof. Eran Dolev Signature
physician

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