Typhus: War Fever

Aliases: typhus, murine typhus, endemic typhus, epidemic typhus, war fever

The ides of March, the day one of the greatest military commanders in history died, is an appropriate time to explore the theme of combat. And there is no better illness to illustrate its intersection with disease than typhus. There are two forms of typhus: endemic, which is consistently present in the population at a predictable level, and epidemic, which is not commonly found, and occurs at unpredictably high levels. The second type has plagued battlefields and barracks for centuries, earning it the grisly nickname, war fever.

While epidemic typhus has helped bring many armies to their knees, it may have had the largest impact on the troops of a modern Cesar, Napoleon. Napoleon’s Grand Armée, a staggering force of 500,000 men, was gathered together for one purpose: to conquer Russia. In June 1812, the troops began their invasion by crossing the Niemen River in Poland, and by December, approximately 220,000 of them had died of disease. Although the Grand Armée was destroyed by a combination of factors, clearly disease played a major role.

typhus
Grand indeed.

It should be no surprise that epidemic typhus emerged amidst the Russian campaign. The conditions were– as they so often were in war– perfect. The supply lines were woefully inadequate, stressing the troops with hunger and thirst, and forcing them to forage (aka pillage) in the countryside, where they encountered the lice-ridden peasantry. This situation was exacerbated by Russia’s “scorched earth” policy, where they withdrew from the front, burning resources as they went. Dysentery was rampant, weakening the troop’s immune systems and morale. And the infamous winter weather, personified as General Frost, encouraged the soldiers to huddle for warmth, increasing disease spread.

The collapse of Napoleon’s great fighting force demolished not only his dreams of ruling Russia, but also his reputation of invincibility. This loss radically changed the perception of his abilities as a commander, and the loss of so many troops seriously impacted his future fighting capabilities1. This is an acute example of the impact of disease in war: in 1812, typhus changed history.

Cause: Both forms of typhus are caused by a bacterial pathogen in the genus Rickettsia, but they are transmitted differently. Endemic or murine typhus is caused by Rickettsia typhi, and is spread through contact with the fleas or feces of infected rats, cats, opossums, raccoons, or skunks2. Epidemic typhus is caused by Rickettsia prowazekii, and is transmitted by contact with the feces of body lice that have fed on infected people1.

Consequence: The symptoms of endemic and epidemic typhus are similar. Both include headache, joint and muscle pain, a rash that originates on the chest and spreads all over the body, and a high fever (104-106°F) that can last up to two weeks. However, epidemic typhus is much more severe, and can also result in delirium, chills, coughing, sensitivity to light, low blood pressure, and petechiae (bleeding into the skin). In addition to the above symptoms, endemic typhus may also cause abdominal pain, nausea, and vomiting2.

Cure: Antibiotics, such as doxycycline and tetracycline, are extremely effective in treating both types of typhus. However, early diagnosis and treatment are critical, especially for epidemic typhus: 10-60% of untreated cases of epidemic typhus and 2% of untreated endemic typhus cases will be fatal, with people over 60 particularly at risk2.

References

1. Peterson, RKD. (1995). Insects, disease, and military history: The Napoleonic campaigns and historical perspective. American Entomologist, 147-160.

2. Typhus. MedlinePlus. 6 October 2012. Web. 7 March 2014.

Image credit: Creative Commons, https://en.wikipedia.org/wiki/Napoleon_I_on_his_Imperial_Throne