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A Model for Experimental Exposure of Humans to Larval Ixodes scapularis Ticks

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Epidemic typhus.

Yassina Bechah¹, Christian Capo, Jean-Louis Mege

¹Unit for Research on Emergent and Tropical Infectious Diseases (URMITE), CNRS-IRD UMR 6236, Faculty of Medicine, University of the Mediterranean, Marseille, France.

The Lancet. Infectious Diseases

|June 28, 2008

Summary

Epidemic typhus, caused by Rickettsia prowazekii, remains a threat due to body lice. Understanding its transmission, including from flying squirrels and reactivation, is key to control.

Area of Science:

Medical Entomology
Infectious Diseases
Bacteriology

Background:

Epidemic typhus, caused by Rickettsia prowazekii, is transmitted by the body louse (Pediculus humanus corporis) and remains a public health concern.
Poor sanitation facilitates louse proliferation, contributing to the disease's persistence despite antibiotic availability.
Rickettsia prowazekii was historically confined to humans and body lice, but new reservoirs and transmission dynamics have been identified.

Purpose of the Study:

To review the transmission dynamics of epidemic typhus, including novel reservoirs and reactivation.
To highlight the significance of Brill-Zinsser disease as a potential source of recurrent epidemics.
To underscore the potential bioterrorism threat posed by Rickettsia prowazekii.

Main Methods:

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Literature review of Rickettsia prowazekii epidemiology and pathogenesis.
Analysis of historical and recent data on epidemic typhus outbreaks.
Evaluation of the role of flying squirrels (Glaucomys volans) and Brill-Zinsser disease in disease transmission.

Main Results:

Rickettsia prowazekii infection is linked to contact with flying squirrels in the USA.
Brill-Zinsser disease, a relapsing form, can reactivate from persistent infection and cause sporadic cases unrelated to louse infestation.
The bacterium is stable in dried louse feces and can be aerosolized, posing a bioterrorism risk.

Conclusions:

Understanding the multifaceted transmission of Rickettsia prowazekii, including sylvatic and human-to-human cycles, is crucial for effective control.
Reactivation of latent infections (Brill-Zinsser disease) can initiate new outbreaks.
Rickettsia prowazekii represents a significant biodefense concern requiring enhanced surveillance and preparedness.