Relapsing Fever in California

Transcription

1 Relapsing Fever in Califrnia GILES S. PORTER, M.D., M. DORTHY BECK, AND I. M. STEVENS, F.A.P.H.A. Califrnia State Department f Public Health, San Francisc, Calif. ENDEMIC fcuses f relapsing fever have been reprted in Clrad, Texas, and Califrnia. In 1921, Dr. Le Ry Briggs f San Francisc reprted 2 cases in which the infectin was cntracted at Plaris n the Truckee River, Califrnia. The diagnsis f bth was cnfirmed by the demnstratin f spirchetes in the bld and bth respnded t treatment with nearsphenamin. These patients had been bitten n the legs by insects. Urticarial marks n their legs and bld spts n the bedding warranted this cnclusin, but n bedbugs culd be fund and n ticks were seen at any time during the trip. N further evidence f relapsing fever came t the attentin f the Califrnia State Department f Public Health until September, 193, when Dr. Gerge Stevens, Epidemilgist, Ls Angeles City Department f Health, reprted a case in a schl teacher wh had lived at Big Bear Lake during July and August. Abut August 1 she suddenly develped a high fever, severe headache, generalized tenderness f the muscles, and slight dizziness. This illness lasted abut 5 days and the patient was well until abut August 15. The case was diagnsed during her furth relapse n September 16 and the diagnsis cnfirmed by finding the spirchetes in the bld smear. The patient culd nt recall having been bitten by any insects but had nticed a red spt n her neck which she thught might have been a bite. She had nt seen any bedbugs r ticks while there. In Octber, 193, Majr V. H. Crnell, Letterman General Hspital, U. S. Army, reprted, thrugh the curtesy f the Cmmanding Officer, a case in which the infectin had been cntracted at Lake Tahe where the patient had been frm July 9 until July 24. His nset was July 27. The diagnsis was established September 8 when spirchetes were demnstrated in the bld smear. He had been bitten by msquites but knew f n ther bites. Early in Nvember, 193, Dr. J. D. Dunshee, Health Officer f Pasadena, reprted a case in a yung man wh had been at Lake Tahe during August. On August 25 this patient had nticed the [11361

2 RELAPSING FEVER IN CALIFORNRA 1137 bite f an insect under the right ear ver the jugular vein which became swllen and very painful and remained swllen fr 4 days. On September 9 he became ill and his symptms recurred at intervals ver a perid f 3 weeks. Spirchetes were fund in bld smears taken Octber 28. When the first case f the 1931 seasn was reprted in July, 1931, the State Bard f Public Health passed a reslutin making relapsing fever a reprtable disease. Cases ther than thse brught t ur attentin had been diagnsed and it was therefre deemed advisable t cnduct an investigatin t determine the incidence f relapsing fever, the fcuses, the ectparasites invlved in the transmissin, and the reservirs f infectin. T date, 3 cases have been recrded. A tabulatin f these is presented here. The histry f Case 25 (C.M.W.) is f interest. This patient was a member f the grup cnducting field studies this year in the fllwing relapsing fever fcuses: Big Bear Valley May 16 t June 4; Lake Tahe June 8 t June 22; and Packer Lake June 23 t June 3. His duties cnsisted f shting and trapping rdents, searching brush and animals fr ectparasites, and labratry wrk. He returned frm Packer Lake June 3, and n the evening f July 1 develped a fever, headache, generalized pains, malaise, and had a severe chill. During the night he had several chills and his fever cntinued. He entered the hspital July 3 with a temperature f 12 F., pains in his chest, and a severe headache. The leukcyte cunt was 13,1 with 89 per cent plymrphnuclears. The fllwing day his temperature was nrmal. Relapsing fever was suspected because he had been wrking in infected areas and spirchetes were demnstrated in the bld smear taken July 4. July 5 his temperature rse t 14 and he was given.3 gm. f nesalvarsan. His temperature gradually became nrmal, but the pains in his chest persisted fr several days and general weakness cntinued fr 2 weeks. A specimen f bld taken July 4 was inculated int white mice and the spirchetes were recvered frm them. June 25, while at Packer Lake, this patient had picked up a bag cntaining 5 rdents recently sht and accidentally smeared sme rdent bld n his hands, n which were several pen lesins, and he washed them in disinfectant as sn as pssible. The pled specimen f bld frm these 5 rdents was inculated int a white muse and spirchetes resembling T. recurrentis were recvered frm the muse. He was nt bitten by any insects t his knwledge nr had he during that trip fund any ticks recgnized as transmitters f

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5 14 AMERICAN JOURNAL OF PUBLIC HEALTH relapsing fever. His labratry accident was fllwed 7 days after with a prven case f relapsing fever. This seems t present evidence that his infectin was cntracted by direct transfer f the spirchetes frm the rdent. The staff cnducting the field studies included a bacterilgist, an entmlgist and tw rdent hunters. All peratins were cnfined t thse 3 areas in which all f the reprted cases cntracted their infectin. This investigatin was made in cllabratin with Dr. K. F. Meyer, Directr f the Hper Fundatin fr Medical Research, University f Califrnia Medical Schl, and with W. B. Herms, Prfessr f Entmlgy, University f Califrnia. A ttal f 894 rdents was either trapped r sht. A field labratry was maintained as near the shting and trapping areas as pssible and bld smears were immediately made frm the heart. During 1931, whenever pssible, bld was taken frm the heart and inculated int white mice. In 1932, animal inculatins were made frm all rdents. Later the animals were carefully cmbed fr ectparasites and then autpsied. All enlarged spleens were remved fr further examinatin. In the first survey, during the fall f 1931, bld smears were made frm each rdent and nly a few bld specimens were inculated int mice. All f these inculatins int mice prved negative but ne bld smear frm a chipmunk sht near Plaris n the Truckee River which shwed a spirchete, and a bld smear frm a squirrel killed at Packer Lake which had a number f spirchetes resembling T. recurrentis. The prgram fr this investigatin in 1932 was changed s as t prvide pprtunity fr pling specimens f bld frm several f the same species f rdents. After making bld smears frm each rdent, pled bld was inculated int white mice. T date spirchetes have been transferred t labratry animals frm 9 chipmunks and 2 squirrels. These findings indicate that the rdents play a part in the epidemilgy f relapsing fever. Whether they serve as reservirs f infectin r whether they receive their infectin frm the ectparasite which als transmits the infectin t man, remains t be prved. Mre detailed reprts will be published when the experimental wrk included in the special investigatin has been cmpleted.