WEBVTT - Ep 86 Typhus: Another lousy episode 0:00:01.440 --> 0:00:05.800 July twenty ninth, eighteen forty seven. The mate continued to 0:00:05.800 --> 0:00:08.920 grow worse, and the mistress was unceasing in her attention 0:00:09.039 --> 0:00:12.680 to him. The day was exceedingly hot and sultry, and 0:00:12.760 --> 0:00:15.320 I could not have remained on deck, but the captain 0:00:15.400 --> 0:00:18.480 spread an awning over it, which kept the cabin cool. 0:00:18.640 --> 0:00:21.239 We lay at some distance from the island, the distant 0:00:21.320 --> 0:00:24.760 view of which was exceedingly beautiful. At the far end 0:00:24.840 --> 0:00:28.560 were rows of white tents and marquees, resembling the encampment 0:00:28.600 --> 0:00:31.720 of an army. Somewhat nearer was the little fort and 0:00:31.800 --> 0:00:35.720 residence of the Superintendent Physician, and nearer still the chapel 0:00:35.880 --> 0:00:38.800 Siemen's Hospital and little village, with its wharf and a 0:00:38.800 --> 0:00:43.720 few sailboats, the most adjacent extremity being rugged rocks, among 0:00:43.760 --> 0:00:47.880 which grew beautiful fir trees at high water. This portion 0:00:48.080 --> 0:00:50.760 was detached from the main island and formed a most 0:00:50.840 --> 0:00:56.200 picturesque islet. But this scene of natural beauty was sadly 0:00:56.240 --> 0:01:00.160 deformed by the dismal display of human suffering that it presented. 0:01:01.080 --> 0:01:04.600 Helpless creatures being carried by sailors over the rocks on 0:01:04.680 --> 0:01:08.360 their way to the hospital. Boats arriving with patients, some 0:01:08.400 --> 0:01:12.200 of whom died in their transmission from their ships. Another, 0:01:12.360 --> 0:01:16.640 and still more awful sight, was a continuous line of boats, 0:01:16.680 --> 0:01:19.319 each carrying its freight of dead to the burial ground 0:01:19.600 --> 0:01:24.880 and forming an endless funeral procession. Some had several corpses 0:01:25.160 --> 0:01:28.240 so tied up in canvas that the stiff, sharp outline 0:01:28.280 --> 0:01:32.720 of death was easily traceable. Others had rude coffins constructed 0:01:32.760 --> 0:01:35.240 by the sailors from the boards of their berths or 0:01:35.280 --> 0:01:39.040 should I say cribs. In a few a solitary mourner 0:01:39.160 --> 0:01:43.200 attended the remains, but the majority contained no living beings 0:01:43.400 --> 0:01:47.160 save the rowers. I could not remove my eyes until 0:01:47.240 --> 0:01:50.160 boat after boat was hid by the projecting point of 0:01:50.200 --> 0:01:54.200 the island, round which they steered their bloomy way. From 0:01:54.280 --> 0:01:57.400 one ship. A boat proceeded four times during the day, 0:01:58.080 --> 0:02:01.200 each time laden with a cargo of day. I ventured 0:02:01.200 --> 0:02:03.640 to count the number of boats that passed, but had 0:02:03.680 --> 0:02:54.440 to give up the sickening task. Oh my goodness. Yeah. 0:02:54.480 --> 0:03:00.360 So that is from a diary that somebody published called 0:03:00.440 --> 0:03:03.840 Famine Ship Diary The Journey of a Coffin Ship, and 0:03:03.840 --> 0:03:07.200 it's written by someone named Robert White, but that's a pseudonym, 0:03:07.960 --> 0:03:13.160 and it tells the story of gross Isle, which is 0:03:13.800 --> 0:03:17.000 a place in Canada where a lot of ships sailed 0:03:17.040 --> 0:03:24.160 to from Ireland during the famine and Typhus was absolutely 0:03:24.360 --> 0:03:28.760 out of control in Ireland on the ships, and it's 0:03:28.880 --> 0:03:33.240 estimated that more than twenty thousand people died from eighteen 0:03:33.320 --> 0:03:35.840 forty seven to eighteen forty eight on these so called 0:03:35.880 --> 0:03:39.560 Coffin ships and also in Canada when they landed. And 0:03:39.600 --> 0:03:43.040 a lot of people who died were mostly people coming 0:03:43.040 --> 0:03:46.240 from Ireland, but also like the doctors and the priests 0:03:46.280 --> 0:03:51.840 and clergymen or someone who attended attended them. So yeah, 0:03:52.840 --> 0:04:01.160 it's really by heartbreaking. God, that's awful. Erin Yeah. Hi, 0:04:01.720 --> 0:04:05.880 I'm Aaron Welsh and I'm Erin alman Updyke and this 0:04:06.040 --> 0:04:08.640 is this podcast will kill you. Welcome. 0:04:08.960 --> 0:04:14.040 We're starting strong clearly to our fifth season. 0:04:14.920 --> 0:04:19.559 Yeah. This is episode eighty six of Yeah, which marks 0:04:19.600 --> 0:04:23.720 the beginning of our fifth season. Feels like it was 0:04:23.839 --> 0:04:27.960 just yesterday that we recorded alcohol it was it kind 0:04:27.960 --> 0:04:31.839 of was kind of was, But we're excited to be 0:04:31.920 --> 0:04:35.760 back and we're excited to do this episode. This topic, 0:04:35.839 --> 0:04:38.520 I mean, this is a this is a big one. 0:04:38.520 --> 0:04:41.520 It almost rightly belongs in Like our first season. 0:04:42.120 --> 0:04:44.480 I think it was a strong first season contender, and 0:04:44.520 --> 0:04:46.960 it's just taken us four extra seasons to get here. 0:04:47.880 --> 0:04:51.359 It's gonna be a very interesting episode, I think. I 0:04:51.360 --> 0:04:54.919 think so too. I gained a new appreciation for lice. 0:04:55.120 --> 0:04:57.400 I can't wait to talk about lice in like more 0:04:57.440 --> 0:04:58.679 detail than people want. 0:04:59.320 --> 0:05:02.400 I know, lifes are so fascinating. I think this just 0:05:02.440 --> 0:05:05.200 like goes to show that we got our PhDs in 0:05:05.240 --> 0:05:11.440 the right field. I was thinking the same thing. We 0:05:11.480 --> 0:05:14.520 are true vector borne disease ecologists of heart, I think 0:05:14.600 --> 0:05:21.479 really are. Yeah, Okay, so Aaron, Yes, what time is it? 0:05:21.480 --> 0:05:24.800 It is quarantiney time it is? 0:05:26.160 --> 0:05:27.920 And what are we drinking this week? 0:05:28.080 --> 0:05:32.040 This week we're drinking the sous Laus. 0:05:31.560 --> 0:05:35.760 The saust Laus. I love it. And in the South, 0:05:35.960 --> 0:05:42.000 louse is basically it's like a you know, a bourbon eggnog. Yeah, 0:05:42.040 --> 0:05:44.040 you can do rum if you want. I'm gonna do bourbon. 0:05:44.839 --> 0:05:48.839 And I've never made eggnog before in my life, like 0:05:48.880 --> 0:05:51.320 I've only ever just gotten it from the store. But 0:05:51.600 --> 0:05:53.880 I made it for the first time and it is 0:05:54.360 --> 0:05:56.240 really delicious, Like. 0:05:56.279 --> 0:06:00.599 I've never had eggnog that I've enjoyed, so I would 0:06:00.640 --> 0:06:02.320 like to try your eggnog please. 0:06:03.680 --> 0:06:08.239 Okay, but yeah, part of the reason that I wanted 0:06:08.279 --> 0:06:12.520 to do an eggnog for this is because Harold Cox 0:06:12.600 --> 0:06:15.160 I think was his name, was a researcher at Rocky 0:06:15.200 --> 0:06:18.440 Mountain Labs in Hamilton, Montana, which we talked about in 0:06:18.440 --> 0:06:21.960 our Rocky Mountain Spot a Fever episode, and he developed 0:06:22.040 --> 0:06:25.320 a typhus vaccine in egg yolks, and so I thought, 0:06:25.440 --> 0:06:28.840 you know what, let's do an eggnog. And also, like, 0:06:29.160 --> 0:06:33.400 this episode's supposed to come out December, so perfect feels 0:06:33.440 --> 0:06:34.760 like a good seasonal BEV. 0:06:35.279 --> 0:06:39.599 So we'll post the full recipe for that quarantini as 0:06:39.640 --> 0:06:43.520 well as the non alcoholic version r plasy Brita on 0:06:43.560 --> 0:06:45.600 our website. This podcast will kill you dot Com and 0:06:45.720 --> 0:06:47.279 all of our social media channels. 0:06:47.600 --> 0:06:50.400 We will. And I just want to add that don't 0:06:50.400 --> 0:06:54.920 feel compelled to homemake eggnog like and you know, there 0:06:54.920 --> 0:06:56.880 are tons of options out there at the store, and 0:06:56.920 --> 0:07:00.440 there are tons of non dairy options and vegan options 0:07:00.440 --> 0:07:03.800 as well, so take your pick. Really it works with 0:07:05.040 --> 0:07:11.240 eggish nug Yeah, eggish noob Okay, other podcast business. 0:07:12.040 --> 0:07:15.680 As always, this podcast will kill you. Dot com is 0:07:15.680 --> 0:07:17.520 our website and it's pretty great. 0:07:17.520 --> 0:07:18.320 You should check it out. 0:07:18.400 --> 0:07:21.760 We have links to our Goodreads list and our bookshop 0:07:21.760 --> 0:07:24.320 dot org affiliate account. We have links to plodmobile, our 0:07:24.400 --> 0:07:28.640 music who's also on Spotify. We've got links to our Patreon. 0:07:28.760 --> 0:07:31.240 We've got merch, so much cool merch. Did you get 0:07:31.280 --> 0:07:32.400 your holiday gifts yet? 0:07:32.640 --> 0:07:36.240 Aaron, What am I missing? I honestly, I don't know. 0:07:36.320 --> 0:07:38.720 I'm just glad that you went through so many of 0:07:38.760 --> 0:07:41.080 them that I wasn't even I was like, she's got it, 0:07:41.160 --> 0:07:45.960 She's got it covered totally. Oh transcripts. Transcripts. Yeah, see, 0:07:46.040 --> 0:07:48.360 I wasn't even. I don't want to say I wasn't 0:07:48.400 --> 0:07:51.280 paying attention, but I just had full confidence that you 0:07:51.320 --> 0:07:57.400 have a thinks I appreciate that. So before we begin, 0:07:58.200 --> 0:08:02.840 I just want to thank everyone who suggested topics to 0:08:02.920 --> 0:08:08.080 cover for this season, Like we got so many amazing requests, 0:08:08.160 --> 0:08:10.200 so I think that we can essentially keep doing this 0:08:10.200 --> 0:08:14.120 podcast until the end of time because literally like hundreds 0:08:14.160 --> 0:08:16.320 and hundreds of suggestions so. 0:08:16.440 --> 0:08:20.560 Yes and really good ones, really good ones, and we 0:08:20.640 --> 0:08:23.559 also heard from listeners who really wanted to hear more. 0:08:23.880 --> 0:08:28.160 In our diabetes episode about obesity and fat phobia, and 0:08:28.280 --> 0:08:31.360 in our alcohol episode, people wanted to hear more about addiction, 0:08:31.560 --> 0:08:33.760 and both of those are huge topics that we're hoping 0:08:33.800 --> 0:08:35.120 to tackle in future episodes. 0:08:35.520 --> 0:08:38.520 Yeah. Absolutely, we wanted to give them the time that 0:08:38.559 --> 0:08:43.200 they deserve and so like devote entire episode or episodes 0:08:43.200 --> 0:08:43.720 to those. 0:08:43.800 --> 0:08:46.720 So yeah, exactly and ear out. 0:08:48.040 --> 0:08:51.800 Okay with that? Should we should we do it? I 0:08:51.880 --> 0:08:53.680 think it's yeah, I think we should. Let's take a 0:08:53.720 --> 0:08:57.160 quick break and then tell me all about typhus. 0:09:21.160 --> 0:09:25.360 So if you just hear the word typhus listeners, not 0:09:25.480 --> 0:09:28.800 Aaron who just researched typhus for a long time, you 0:09:29.040 --> 0:09:32.480 might think one of a few different things. You might 0:09:32.520 --> 0:09:34.600 actually think of typhoid, which I. 0:09:35.320 --> 0:09:37.080 Know I keep. There were a few times when I 0:09:37.120 --> 0:09:39.719 had to correct in my notes that said typhoid, and 0:09:39.720 --> 0:09:40.920 I'm like, why am I doing this? 0:09:41.200 --> 0:09:45.120 Yeah, we covered typhoid in the season opener of our 0:09:45.280 --> 0:09:51.079 last season, and this isn't that so typhoid and typhus 0:09:51.200 --> 0:09:52.559 are two different. 0:09:52.280 --> 0:09:55.120 Groups of fevers. But then even if. 0:09:55.040 --> 0:09:58.360 You are thinking about typhus, there's at least three different 0:09:58.400 --> 0:10:05.199 diseases that are called typhus. There's mirroring scrub and epidemic varieties, 0:10:06.080 --> 0:10:09.360 and they all have additional names just to really keep 0:10:09.400 --> 0:10:12.920 things interesting in this episode today we are not going 0:10:12.960 --> 0:10:17.439 to cover all of these forms of typhus. But although 0:10:17.480 --> 0:10:20.920 we're only focusing on one of these Typhus fevers, the 0:10:21.000 --> 0:10:23.120 truth is that by the end of this episode you 0:10:23.200 --> 0:10:26.560 will actually know kind of a lot about all of 0:10:26.600 --> 0:10:30.520 the different kinds of Typhus fevers, just because while these 0:10:30.559 --> 0:10:33.640 three diseases differ both in terms of their causative agents 0:10:34.120 --> 0:10:39.040 and their transmission routes and their ecology and epidemiology, they're 0:10:39.120 --> 0:10:42.800 quite different, but in terms of the actual disease or 0:10:42.920 --> 0:10:46.720 illness that they cause, they're not all that different. 0:10:48.160 --> 0:10:53.440 That's really interesting, like convergent disease characteristics. 0:10:53.520 --> 0:10:57.040 Well, the truth is they're just caused by really similar pathogens. 0:10:57.080 --> 0:10:58.880 So let's get into it briefly. 0:10:59.400 --> 0:11:02.040 I'll quickly mentioned the other two and then we'll get 0:11:02.040 --> 0:11:05.959 into the meat of the episode, which is epidemic typhus. 0:11:07.240 --> 0:11:11.960 So first, there's scrub typhus, which is also called bush typhus. 0:11:11.960 --> 0:11:16.120 Both of those are not great names, but they're caused 0:11:16.120 --> 0:11:20.959 by a bacterium known as Orientia sutsugum mushi and I 0:11:21.040 --> 0:11:25.720 might have pronounced that horribly. But this form of typhus 0:11:25.800 --> 0:11:29.680 is transmitted by the bites of infected mites laurevil mites, 0:11:29.720 --> 0:11:32.120 which you may know of as triggers. 0:11:32.800 --> 0:11:33.240 Uh huh. 0:11:33.440 --> 0:11:36.760 Very familiar, very very too familiar with them. 0:11:36.840 --> 0:11:41.320 Yeah, intimately familiar from thanks to yeah, Kentucky and Panama 0:11:41.360 --> 0:11:44.040 and sitting in the grass when I should not have. 0:11:44.440 --> 0:11:49.640 Never sit in the grass. So that's scrub typhus. There's 0:11:49.679 --> 0:11:53.680 also mirroringe typhus, which is also called fleaborne typhus or 0:11:54.080 --> 0:11:57.320 very confusingly endemic typhus. 0:11:57.559 --> 0:11:59.000 Very confusingly indeed. 0:12:00.960 --> 0:12:05.760 So this is a disease caused by Ricketsia typhee, which 0:12:05.800 --> 0:12:10.360 is also confusing because typhee And anyways, yeah, it's caused 0:12:10.360 --> 0:12:13.080 by a bacterium called Ricketzia typhee. 0:12:13.679 --> 0:12:15.439 And this form of typhus is. 0:12:15.400 --> 0:12:19.600 Transmitted by the feces of fleas aka flea dirt, as 0:12:19.600 --> 0:12:24.400 we learned in our Bartonella episode. And then there is 0:12:24.920 --> 0:12:28.360 epidemic typhus, and epidemic typhus is what we're going to 0:12:28.400 --> 0:12:35.400 focus on today. Epidemic typhus is also aka lousbourne typhus, 0:12:36.120 --> 0:12:40.439 and this form is caused by the bacterium Ricketzia prow azechii. 0:12:41.320 --> 0:12:46.520 So this typhus Ricketzia prow ezechii is transmitted by the 0:12:46.559 --> 0:12:47.800 poop the feces. 0:12:48.200 --> 0:12:49.079 Also, is it. 0:12:49.040 --> 0:12:52.679 Also called dirt I'm not sure of lice. And we're 0:12:52.679 --> 0:12:56.600 going to get into more detail, like deep detail about 0:12:56.640 --> 0:12:59.520 that transmission cycle in just a second, but just to 0:12:59.600 --> 0:13:05.760 kind of up these other typhee fevers, So scrub typhus 0:13:05.760 --> 0:13:10.640 andmurine typhus are similar diseases, and in truth, the pathogens 0:13:10.720 --> 0:13:13.840 are very similar. So murine typhus is also caused by 0:13:13.880 --> 0:13:18.360 a Ricketsia and often you see meurine or endemic typhus 0:13:18.400 --> 0:13:21.960 and epidemic typhus grouped together into what are called typhus 0:13:21.960 --> 0:13:27.240 group ricketzioses. So these are very similar diseases. Endemic or 0:13:27.400 --> 0:13:31.480 murine typhus tends to be a less severe disease for 0:13:31.520 --> 0:13:32.559 the most part. 0:13:32.880 --> 0:13:36.680 And is Ourentia is that a group that's closely related 0:13:36.679 --> 0:13:39.400 to Ricketzia. Okass that I was just gonna say. 0:13:40.240 --> 0:13:44.240 Yeah, So scrub typhus caused by an Orentia bacterium is 0:13:44.360 --> 0:13:47.240 in the same family of Ricketsia, So it's a different 0:13:47.280 --> 0:13:49.240 genus but very similar in. 0:13:49.360 --> 0:13:54.440 Truth, like intracellular super reduced genome. Okay, exactly, Yeah. 0:13:54.520 --> 0:13:56.440 I think it's a little bit larger of a genome 0:13:56.480 --> 0:13:59.800 than a Ricketsia, but it's still it's an intracellular and 0:14:00.080 --> 0:14:03.920 the disease looks very similar can also be very severe. 0:14:04.520 --> 0:14:09.880 But historically, as you'll get into aarin epidemic, Typhus has 0:14:09.920 --> 0:14:14.160 caused the most severe and widespread disease worldwide. 0:14:14.280 --> 0:14:18.240 Way more than I had even thought before. Exactly. 0:14:18.520 --> 0:14:23.040 Yeah, yeah, So that's what we're going to focus on today. 0:14:24.200 --> 0:14:28.600 Ricketsia prow a zechii, like I said, transmitted by the 0:14:28.600 --> 0:14:35.640 feces of the human body louse pendiculous Humanis corporus, one 0:14:35.640 --> 0:14:40.280 of our old friends from Bartonella, right, m h. And 0:14:40.560 --> 0:14:42.800 I'm going to go into more detail about the human 0:14:42.840 --> 0:14:44.880 body louse, and I know you are to erin. 0:14:45.160 --> 0:14:46.800 I'm excited me too. 0:14:47.040 --> 0:14:50.080 It's so interesting as a vector for a few reasons. 0:14:50.080 --> 0:14:52.360 And I don't think we really got into this in 0:14:52.400 --> 0:14:55.280 Bartnella because we were covering so much ground, but I 0:14:55.360 --> 0:14:57.760 know that we did talk in our Bartnella episode about 0:14:58.120 --> 0:15:03.640 just how host specific insect is lice are so specific 0:15:03.720 --> 0:15:07.520 to their individual host species that the human body louse 0:15:07.680 --> 0:15:11.720 is a separate louse than the human head louse like asterisk. 0:15:12.960 --> 0:15:19.200 Oh oh, well, separate subspecies asterisk. Oh okay, Oh my gosh, 0:15:19.280 --> 0:15:20.200 you're killing. 0:15:19.920 --> 0:15:21.479 Me here, I'm sorry. 0:15:21.520 --> 0:15:27.760 All right, Well, anyways, historically they have been which is intense. Yeah, 0:15:27.800 --> 0:15:30.800 and part of this intensity lies in the fact that 0:15:30.840 --> 0:15:35.360 lice are really very fragile creatures, so they can live 0:15:35.480 --> 0:15:38.640 up to four to twelve weeks. And body lice generally 0:15:38.680 --> 0:15:42.520 live in and on our clothing for the entirety of 0:15:42.560 --> 0:15:48.080 their life cycle. But they're incredibly sensitive to temperature and humidity. 0:15:48.400 --> 0:15:52.360 So if their host I e. Us humans, for example, 0:15:52.480 --> 0:15:56.880 comes down with a fever, lice will flee their hosts. 0:15:57.720 --> 0:16:03.000 So I have a quote about lice fleeing their hosts. 0:16:04.000 --> 0:16:07.440 When Thomas Beckett died in the twelfth century and his 0:16:07.520 --> 0:16:11.360 body was laid out for the public funeral, onlookers noted 0:16:11.480 --> 0:16:14.840 that as his body cooled, the lice living in his 0:16:15.040 --> 0:16:18.880 clothes began to crawl out and quote boiled over like 0:16:19.000 --> 0:16:22.880 water in a simmering cauldron. And the onlookers burst into 0:16:22.920 --> 0:16:24.400 alternate weeping and laughter. 0:16:25.560 --> 0:16:27.560 Oh no, no, no, no, no, that's a. 0:16:27.520 --> 0:16:29.880 Lot of lice. That's a lot of lice. 0:16:31.440 --> 0:16:37.320 Okay, Well, with that lovely image in mind. Lice are 0:16:37.400 --> 0:16:41.960 also very susceptible to dehydration, so in addition to human 0:16:41.960 --> 0:16:46.360 body temperature, humidity is really important. So they're poop, which 0:16:46.480 --> 0:16:51.520 again is what contains the infectious bacteria, is really really 0:16:51.680 --> 0:16:56.960 dry and powdery, which is an image that I never 0:16:57.240 --> 0:16:57.920 had thought of. 0:16:58.480 --> 0:16:58.880 Mm hmm. 0:16:59.320 --> 0:17:02.160 But their poop is only like two percent water. 0:17:03.040 --> 0:17:07.080 Wow, uh huh. They're very efficient extrac creatures. 0:17:08.119 --> 0:17:11.280 I looked it up for reference, and our body poop 0:17:11.600 --> 0:17:13.080 is like seventy five percent water. 0:17:13.320 --> 0:17:16.040 Okay, come on, we gotta do better than that. Although 0:17:16.240 --> 0:17:16.840 pretty good. 0:17:17.200 --> 0:17:22.239 Yeah, Anyways, that's a long divergence. But all of that 0:17:22.359 --> 0:17:24.760 is to say that lice living in and on our 0:17:24.800 --> 0:17:27.640 clothes they have to blood feed all the day time, 0:17:27.680 --> 0:17:30.600 like five times a day every day for weeks on end, 0:17:31.240 --> 0:17:34.000 and while they're doing that in our bloodstream, they pick 0:17:34.080 --> 0:17:39.240 up these ricketsia. Now, then what happens is that these 0:17:39.280 --> 0:17:45.479 bacteria can infect the louse gut lining the cells that 0:17:45.560 --> 0:17:50.240 line the lice's gut their epithelial cells directly, they replicate 0:17:50.520 --> 0:17:53.320 in the gut cells of the lice, and then they 0:17:53.359 --> 0:17:56.879 burst out of those cells, which is how the bacteria 0:17:57.000 --> 0:18:00.280 gets into the feces and then is transmitted to us 0:18:00.600 --> 0:18:03.960 when we scratch that dry, flaky poop into all of 0:18:04.000 --> 0:18:06.680 our bite wounds or rub it into our eyes or nose, 0:18:06.720 --> 0:18:11.439 et cetera. However, this whole bursting out of the epithelial 0:18:11.480 --> 0:18:14.479 cells thing also goes the other way in the louse, 0:18:14.760 --> 0:18:17.919 causing blood like our human blood that they just sucked 0:18:18.000 --> 0:18:21.120 up to enter the body cavity of the lice because 0:18:21.119 --> 0:18:25.439 the Racketzia just burst open their fragile, tiny gut. The 0:18:25.560 --> 0:18:29.120 lice that are infected then become visibly red because they're 0:18:29.200 --> 0:18:32.440 full of blood that's no longer in their guts, it's 0:18:32.520 --> 0:18:35.159 just in their body cavity, and they die within a 0:18:35.200 --> 0:18:39.320 week of infection. I have no idea that this disease 0:18:39.440 --> 0:18:42.399 kills the vectors that it uses to maintain its life cycle. 0:18:42.680 --> 0:18:49.760 It's really interesting, and I have included a very touching 0:18:50.280 --> 0:18:55.640 quote about the poor louse and it's unfortunate journey when 0:18:55.680 --> 0:18:57.680 it encounters Typhos specterium. 0:18:57.960 --> 0:18:59.000 That's exactly how I felt. 0:18:59.000 --> 0:19:01.920 I was like this, poor lao, yeah, yeahhh, I think 0:19:01.920 --> 0:19:03.800 you'll really like it. I'm saving it for later, but 0:19:03.880 --> 0:19:04.480 I can't. 0:19:04.240 --> 0:19:08.800 Wait for it. But also spoilers keep that whole, like 0:19:08.920 --> 0:19:12.560 infecting the lining of something and then bursting out that thing. 0:19:12.640 --> 0:19:15.840 In mind, that's a spoiler for human disease. 0:19:15.560 --> 0:19:18.960 Too, And so for humans, in order to get infected, 0:19:19.000 --> 0:19:21.399 it really just has to be like you said, you 0:19:21.400 --> 0:19:23.359 can either rub it in a cut or stick it 0:19:23.440 --> 0:19:25.480 up your nose or in your eye. So it really 0:19:25.600 --> 0:19:28.560 is like pretty infectious in that way. Yes it is. 0:19:28.680 --> 0:19:31.680 And this is a disease that thrives when humans are 0:19:31.680 --> 0:19:36.000 in very close contact, sharing their clothing or having close 0:19:36.040 --> 0:19:40.040 bodily contact in short enough timeframes that either these lice 0:19:40.560 --> 0:19:44.359 or their poop can then be transmitted person to person 0:19:44.480 --> 0:19:48.560 and complete the life cycle. Right, okay, but yes, so 0:19:49.320 --> 0:19:53.240 it also even if the lice dies, all of that, 0:19:53.400 --> 0:19:56.400 like fluid from that dead louse is infectious as well. 0:19:57.600 --> 0:20:01.760 So scratching like the lice bodies themselves into your body 0:20:02.200 --> 0:20:03.480 can can cause infection. 0:20:03.960 --> 0:20:07.000 And do we know anything about the infectious dose? You know, 0:20:07.080 --> 0:20:07.400 I don't. 0:20:07.440 --> 0:20:09.879 I didn't see that anywhere. There's a few things that 0:20:09.920 --> 0:20:11.359 I just simply did not find. 0:20:11.800 --> 0:20:15.679 We'll get to them. That was one of them. But 0:20:16.320 --> 0:20:17.000 once we. 0:20:17.119 --> 0:20:20.600 Humans are infected, the incubation period, so the time from 0:20:20.640 --> 0:20:23.360 that infection to when we show symptoms is usually ten 0:20:23.400 --> 0:20:25.880 to fourteen days, which is actually kind of a long time. 0:20:27.280 --> 0:20:31.359 And then after that, symptoms generally start with like one 0:20:31.480 --> 0:20:37.120 to three days of just feeling cruddy, like nonspecific malaise, 0:20:37.280 --> 0:20:42.080 just feeling bad before the more kind of typical symptoms, 0:20:42.440 --> 0:20:47.240 which start with a fever a fever. Of course this 0:20:47.280 --> 0:20:48.239 podcast will kill you. 0:20:49.480 --> 0:20:52.440 He's an opener. AKA, it started with a fever. 0:20:53.440 --> 0:20:58.200 And this fever usually persists throughout the course of illness 0:20:58.640 --> 0:21:01.840 until a person I dies or recovers. So it's not 0:21:01.920 --> 0:21:04.800 like a fluctuating fever. It's just you have a fever 0:21:04.960 --> 0:21:06.080 and it's going to stay like that. 0:21:06.680 --> 0:21:09.359 And is it a high fever or is it a 0:21:09.440 --> 0:21:11.600 mild fever like it really depends. 0:21:11.760 --> 0:21:14.080 It really depends. Yeah, it kind of varies. 0:21:14.600 --> 0:21:18.800 And so does that suggest that the ricketsier replicate better 0:21:18.960 --> 0:21:22.280 at fever temperatures or is it a defense or do 0:21:22.320 --> 0:21:22.560 we know? 0:21:22.840 --> 0:21:26.920 Very good question that I don't know that I don't 0:21:26.960 --> 0:21:27.600 know the answer to. 0:21:27.840 --> 0:21:29.919 What a good question, thank you. 0:21:31.840 --> 0:21:34.840 But in addition to fever, there's also usually a pretty 0:21:34.920 --> 0:21:38.840 sudden onset of a very severe headache, and it's also 0:21:38.880 --> 0:21:43.159 common to have like abdominal pain. But otherwise, other than 0:21:43.200 --> 0:21:47.640 those things, symptoms are very nonspecific. Everything from myalgias which 0:21:47.640 --> 0:21:51.679 are muscle aches, are thralgias, which are joint pain. Maybe 0:21:51.720 --> 0:21:55.280 you'll have some chills because you have this fever, maybe 0:21:55.440 --> 0:21:58.520 anorexia or lack of hunger, not eating anything because you're 0:21:58.560 --> 0:22:03.359 just feeling really bad. If it's left untreated, about eighty 0:22:03.400 --> 0:22:06.520 percent of people will go on to have central nervous 0:22:06.520 --> 0:22:10.520 system involvement, which can be very severe. It can be 0:22:10.680 --> 0:22:15.920 delirium or seizures or coma, which can lead to death, 0:22:17.440 --> 0:22:22.600 and very commonly rashes are apparent. But the thing about 0:22:22.680 --> 0:22:26.679 these rashes is it's not like a single rash, you know, 0:22:26.960 --> 0:22:30.080 like with lime disease. It's like, oh, the classic bulls eye, 0:22:30.880 --> 0:22:33.800 It's nothing like that. In some people, they'll have these 0:22:33.840 --> 0:22:38.240 like red splotchy patches interspersed with areas that if you 0:22:38.440 --> 0:22:42.199 press on them, they'll blanch, which makes they'll like you know, 0:22:42.240 --> 0:22:47.600 go to white. But then it also can either progress 0:22:47.720 --> 0:22:50.680 to or just start out as these like smaller red 0:22:50.720 --> 0:22:54.200 spots that don't blanch when you press on them, or 0:22:54.520 --> 0:22:58.199 you can have petikia, which are like pinpoint red to 0:22:58.320 --> 0:23:01.240 purple little spots all over, like teeny tiny little dots 0:23:01.960 --> 0:23:04.720 all the way up to like larger purplish splotches. 0:23:05.560 --> 0:23:08.240 Huh okay. And it is that like a stage of 0:23:08.280 --> 0:23:11.600 the disease type of thing or is it just okay? 0:23:11.760 --> 0:23:12.840 Not from what I can tell. 0:23:13.640 --> 0:23:17.399 And what's interesting is that if you look at older studies, 0:23:18.400 --> 0:23:21.200 older studies of typhus will say like one hundred percent 0:23:21.200 --> 0:23:23.320 of people or like a very high percentage of people 0:23:23.680 --> 0:23:27.159 all have some kind of rash at some point, but 0:23:27.520 --> 0:23:30.960 some reports, more recent reports, say only twenty to forty 0:23:31.040 --> 0:23:36.320 percent of people have a rash. Unsurprisingly, it's likely because, 0:23:36.520 --> 0:23:39.120 especially more recent studies that have come out of Africa, 0:23:39.960 --> 0:23:42.560 rashes in darker skin and we've talked about this a 0:23:42.600 --> 0:23:46.320 lot on this podcast are either not present, or not 0:23:46.560 --> 0:23:51.600 apparent or not appropriately identified, and so a lot of 0:23:51.640 --> 0:23:54.679 these studies, especially out of Africa, have been ones that 0:23:54.720 --> 0:23:58.440 have reported a lot lower incidents of these rashes associated 0:23:58.440 --> 0:24:01.680 with epidemic typhus. And like even the things like whether 0:24:01.800 --> 0:24:05.240 something blanches turns back to white, like that's the definitions 0:24:05.280 --> 0:24:06.960 that we use, and that's not going to happen in 0:24:06.960 --> 0:24:08.639 the same way on darker skin as it does on 0:24:08.760 --> 0:24:14.520 lighter skin. So that's the rash, which isn't specific to 0:24:14.600 --> 0:24:24.120 begin with, but that's generally the course of epidemic typhus. Now, overall, 0:24:24.800 --> 0:24:27.920 pre antibiotics, like before we had any kind of treatment, 0:24:28.320 --> 0:24:30.800 mortality rates were estimated to be as high as like 0:24:30.880 --> 0:24:33.800 sixty percent, which is very very high. 0:24:34.160 --> 0:24:36.280 That's ridiculously high. 0:24:37.160 --> 0:24:40.960 Now with antibiotics, they are estimated to be as low 0:24:41.000 --> 0:24:43.919 as four percent, which is still very high. 0:24:44.119 --> 0:24:45.920 It's still very high. 0:24:46.080 --> 0:24:49.760 And the reason that epidemic typhus leads to death, or 0:24:49.800 --> 0:24:52.239 the way that it tends to lead to death, can 0:24:52.280 --> 0:24:55.440 be in a few different ways. One it can be 0:24:55.440 --> 0:24:57.800 because of shock, and we'll talk about that a little 0:24:57.800 --> 0:25:01.480 more in just a second. The the other thing is from 0:25:01.560 --> 0:25:05.440 these neurologic manifestations which can lead to coma and lead 0:25:05.480 --> 0:25:10.720 to death. And overall, the biggest risk factors that lead 0:25:10.800 --> 0:25:13.560 to like who is more likely to die versus survive 0:25:13.640 --> 0:25:19.199 and epidemic typhus infection are two biggest things older age 0:25:19.440 --> 0:25:24.440 and malnutrition. So poor nutritional status is very strongly associated 0:25:24.480 --> 0:25:29.680 with severe infection and death compared to good nutritional status. Now, 0:25:29.760 --> 0:25:33.720 before I get into the pathophysiology, because I know you 0:25:33.800 --> 0:25:35.159 have a lot of questions. I can see them on 0:25:35.200 --> 0:25:39.480 your face. I do want to say another interesting thing 0:25:39.600 --> 0:25:44.880 about epidemic typhus, and that is that it actually leads 0:25:45.119 --> 0:25:51.439 to a chronic infection that can then be reactivated many years, 0:25:51.560 --> 0:25:54.639