, MC USN (Ret.) § Rickettsial diseases have affected the military throughout history. Efforts such as those of the Joint U.S. Typhus Commission near the beginning of World War II and of military researchers since have reduced the impact of these diseases on U.S. and Allied forces. Despite the postwar development of effective antibiotic therapies, the newly emerging antibioticresistant scrub typhus rickettsial strains of the Asian Pacific region mandate continued research and surveillance. Similarly, tick-infested training areas in the United States and similar exposure abroad render the spotted fevers and the ehrlichioses problematic to deployed troops. The military continues to work on countermeasures to control the arthropod vectors, as well as actively participating in the development of rapid accurate diagnostic tests, vaccines, and improved surveillance methods. Several rickettsial diseases, including epidemic typhus, scrub typhus, the ehrlichioses, and the spotted fevers, are reviewed, with emphasis on the military historical significance and contributions. Introduction C ertain rickettsial diseases have had a significant impact on military operations throughout history. Before the middle of the 20th century, when effective antibiotics were introduced, military morbidity and mortality rates attributable to diseases such as epidemic typhus and scrub typhus were high. As far back as 429 B.C. and the plague of Athens, as described by Thucydides, typhus was thought to have killed the Athenian general Pericles and caused the downfall of Athens during the Peloponnesian War.1 There are reports in which the destruction of whole armies occurred. Arguably the most famous example is the destruction of the Grand Army of Napoleon following the 1812 withdrawal from Russia, which was attributed, in large part, to typhus and a "lousy" Russian winter. Because symptoms of these diseases often resemble those of other febrile illnesses, such as malaria and leptospirosis, rickettsioses are difficult to diagnose even today (Table I). Consequently, rickettsioses are often underreported or misdiagnosed and their true impact is underestimated. The purpose of this report is to describe the military significance of the rickettsioses and to outline the contributions made by military researchers to minimize the risk to military operations and personnel (Table II). These contributions have also greatly benefited the general public, both in the United States and globally.
Epidemic TyphusEpidemic typhus (also known as louse-borne typhus, camp fever, ship fever, jail fever, and others) is an acute febrile illness of humans. The causative agent, Rickettsia prowazekii, contaminates the feces of its vector, the human body louse, Pediculus humanus. Aerosolized dried feces can be inhaled to induce infection, but the rickettsiae-laden feces are primarily self-inoculated through scratching of the site of the louse bite.3 Fever and headache occur 8 to 12 days following exposure, typically accompanied by generalized maculopapular rash, which spre...