Leptospirosis in French Historical Medical Literature: Weil's Disease or Kelsch's Disease?

Early names for leptospirosis often indicate occupational or environmental exposure. Leptospirosis is hard to identify in the tropical setting because of co-circulating diseases. This is not the case in the temperate setting, such as Europe, where the few historical differential diagnoses were malaria, typhoid, and viral hepatitis. Leptospirosis presumably caused community epidemics in Europe before 1900 and military epidemiologists carefully documented outbreaks in "constrained settings." Achille Kelsch (1841-1911) synthesized available military data and epidemiological perspectives to define "epidemic jaundice" as a nosological continuum, caused by an infectious agent found in muds and water. He viewed Weil's disease as being only one form of that now well-identified disease continuum. The causative pathogen and epidemiological determinants were identified years later. The role of soils and muds as intermediate reservoirs, as suggested by Kelsch, deserves further investigation.

[Adrian Stokes and 'trench jaundice']. / Adrian Stokes en 'trench jaundice'.

On the day that Great Britain declared war on Germany in 1914, the Irish physician and bacteriologist Adrian Stokes travelled to London to volunteer. One week later he left for France with the first British troops as an officer with the Royal Army Medical Corps. He spent most of the First World War attached to No. 1 Mobile Bacteriological Laboratory at the Remy Siding British-Canadian field hospital in Flanders. In April 1916, he was confronted with an outbreak of trench jaundice, also known as epidemic jaundice (Weil's disease). Conditions in the trenches contributed to the hundred cases identified by Stokes in a short period. In 1917, he was the first to publish (in The Lancet) the finding that the bacterium Spirochaeta icterohaemorrhagiae, the causative agent of epidemic jaundice, could be isolated from the kidneys of rats. A subsequent rat control campaign in the trenches successfully curbed the disease.

Discovery of the causative organism of Weil's disease: historical view.

On January 20, 1915, Inada and Ido announced the discovery of the causative agent of Weil's disease. Subsequently, on February 13, 1915, they published the first paper on the discovery of the causative organism (a new species of Spirochaeta) of Weil's disease. Besides discovering the causative organism of the disease, Inada and colleagues clarified the pure culture in medium, and determined the source and route of the infection, its pathology and morbid anatomy; the distribution of the organism in various organs and tissues; the excretion of the spirochete, and its division, filterability, and morphological characteristics; and the clinical picture, laboratory findings, diagnosis, prophylaxis, and treatment of the disease. These studies were conducted by Inada, Ido, Kaneko, Hoki, and Ito, in the years 1914 to 1915. In the early investigation of leptospirosis, Inada and colleagues played a prominent part. We would like to remember these remarkably complete and definitive original achievements on leptospirosis made by Inada and colleagues.

Leptospirosis in Hawaii: shifting trends in exposure, 1907-1984.

Leptospirosis was first recognized as an occupational disease of sugar plantation workers in Hawaii in 1907. Since then, shifts have been noted in the animal transmission cycles, the occupational groups at risk, and an increasing recognition of cases associated with avocational exposure. Surveys of the small mammal populations indicate rats, mice, and mongooses are the most important vectors in Hawaii. Serologic surveys of workers in high-risk occupations show antibody prevalence rates ranging from 12 to 82 percent. The epidemiology of leptospirosis in Hawaii is described, based on 182 cases reported to the Hawaii Department of Health from 1970-1984. The most common infecting serovar was mankarso in the Icterohaemorrhagiae serogroup; other serovars in the Icterohaemorrhagiae group were also frequently implicated as causing disease. The manifestations of disease noted by physicians in Hawaii are similar to those observed in the continental U.S. Fever, myalgia, and headache were the most common symptoms reported in the majority of cases in Hawaii; jaundice was noted in the records of 24 percent. Recommendations made to interrupt the cycle of transmission and reduce the chances of exposure in occupational settings include the control of rodent populations and vaccination of domestic animals. Personal hygiene among workers is to be encouraged, and the development of prophylactic measures is suggested either by immunization or by chemoprophylaxis.

[A type strain or a neotype strain of Leptospira]. / Zur Frage eines Typstammes beziehungsweise Neotypstammes für die Leptospiren.

A deep review of the scientific literature concerning the history of the two oldest icterohaemorrhagiae strains is given in order to promote a decision about the legitimate neotype strain on the genus Leptospira. The strain RGA was found to meet completely the requirements for a Neotype culture given by the International Code of Nomenclature of Bacteria. Its origin from a patient with Weil's disease through guinea pig passages in 1915 is well documented and its culture is unequivocally described by Ungermann in 1916. The strain was maintained in pure culture. Since more than 60 years the strain is used for comparative investigations in classification studies in all laboratories performing such tests. At contrary the history of strain Ictero I is very incomplete. The strain was claimed by Yamamoto to be one of the strain isolated by Inada and Ido in 1915 originally designated as Yamasaki. However, the statement the maintenance of these strains because of loss of virulence was discontinued, is repeatedly mentioned in some old publications of the authors. Moreover it is reported that the strain Ictero I because of contamination with a fungus was recultivated after a passage through a splenectomized mouse, i.e. the strain was not maintained in a pure culture. Beside this it is hardly understandable why has the strain not been submitted to other laboratories before 1965. The strain Ictero I was found to contain an additional thermolabile antigen not present in RGA. At present it is impossible to decide whether this property was already present in the original culture or developed only later, eventually after its mouse passage. Summarizing all these facts, it must be stated that the strain Ictero I cannot be considered to meet all the necessary requirements of its recognition as neotype culture of the Genus Leptospira.