Relapsing fever has been known for over 2,000 years, with the first known description written by Hippocrates in 430 B.C. The disease has caused epidemics throughout history, but a causative species was not identified until 1886, followed by the demonstration of tick transmission in 1904. Major outbreaks occurred in the first half of the 20th century, affecting over 60 million people, but due to improved living conditions relapsing fever no longer produces such large outbreaks.
A Two Thousand Year History
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The Greek physician Hippocrates accurately described relapsing fever during a 5th century B.C. outbreak on the island of Thasos.
Following the ravages of the Justinian Plague, a new epidemic occurred throughout the British Isles with various names in different languages that all translated to the Yellow Plague. Based on the symptoms, this plague has been attributed to louse-borne relapsing fever. The Irish annals date it to circa 550 A.D.
In 1770, Dr. John Rutty described the presence of relapsing fever in Dublin, Ireland. This disease persisted in Ireland and later was a significant contributor to the mortality that occurred during the Potato Famine of the 19th century.
David Livingstone, the British physician, missionary and explorer of Africa, connected the tampan tick-bite with transmission of relapsing fever, based on information provided to him from those familiar with the disease.
Physician Otto Obermeier, in 1866, observed the agent of louse-borne relapsing fever in the blood of a feverish patient, and the bacterium disappeared during remittance of the fever. The bacterium Spirillum Obermeieri (subsequently renamed Borrelia recurrentis) would later be named after Obermeier.
In 1904, Ross and Milne, working in Uganda, and Dutton and Todd in the Congo Free State, discovered an agent of relapsing fever and demonstrated its transmission by ticks. Both Dutton (shown) and Todd were accidently infected during their field studies. Dutton maintained a record of his fever temperatures until he died as a result of the infection.
During the first half of the 20th century, major pandemics of relapsing fever infect over 60 million people with over 5 million deaths.
Dr. Willy Burgdorfer and colleagues report the identification of the agent of Lyme disease, a new Borrelia species subsequently named B. burgdorferi. The researchers’ foundational experience in relapsing fever studies facilitated the discovery.
Smaller outbreaks still occur throughout Africa, Europe and the United States. New species of relapsing fever Borrelia continue to be discovered.
We gratefully acknowledge the graphical talents of Austin Athman for construction of the graphical timeline. PES was supported by the Division of Intramural Research of the National Institute of Allergy and Infectious Diseases, National Institutes of Health.