188 OTHER SPOROZOA 



Phlebotomus Fever 



Of the same general nature as yellow fever and dengue, and 

 concluding this series of gradually milder diseases, is phlebot- 

 omus or three-days' fever. This disease occurs especially on 

 the shores of the Mediterranean and in India, and possibly also 

 in other parts of the world. In endemic countries it occurs in 

 the form of annual epidemics. It is estimated that in the earth- 

 quake regions of Italy where the disease is especially prevalent, 

 50,000 persons are attacked annually, incurring a financial loss 

 of over $7,000,000 by the prolonged incapacitation for work which 

 follows the disease. In central India, every non-immune person 

 is said to be attacked by the end of June each year. 



Phlebotomus fever begins suddenly, like dengue, with a high 

 fever, severe headache and aches in the bones and joints. The 

 nervous symptoms are marked, and the pulse and respiration 

 are accelerated. Usually the fever subsides on the third day, 

 though in India it often lasts four or five days. The aches and 

 general depression continue for ten or twelve days or even longer 

 after the disappearance of the fever. 



The disease, the parasite of which has never been discovered, 

 is transmitted by the gnat or sandfly, Phlebotomus papatasii 

 (see p. 470, and Fig. 212), which is extremely abundant in the 

 regions where phlebotomus fever is endemic. The appearance 

 and habits of this insect are described on p. 471. The prevalence 

 of phlebotomus fever in the earthquake districts is due to the 

 abundance of ideal breeding places for the gnats furnished by 

 the ruined walls. It is possible that other species of Phlebotomus 

 may also transmit the disease. 



The gnats become infective about a week after feeding on an 

 infected person. The incubation period of the disease in man is 

 about four or five days. Natural immunity is extremely rare, 

 but in most cases an immunity of long duration results from an 

 attack of the disease. 



No specific cure has yet been discovered. Prevention lies 

 in avoiding the bites of Phlebotomus papatasii and in reducing 

 their numbers as far as possible by methods described on p. 473. 

 In case of prolonged residence in an endemic region, there is 

 little hope of escaping infection, and willful exposure to it at a 

 time when the disease will be least inconvenient is usually ad- 

 visable, in view of the usually persistent immunity which results. 



