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Ebola virus shares clinical, epidemiologic features with ancient Greek epidemic

An unknown epidemic reported to have occurred in ancient Greece appears to share several clinical and epidemiologic features with present-day Ebola virus, according to recently published report.

Powel Kazanjian, MD, PhD, of the University of Michigan, examined information concerning an unidentified outbreak that occurred in Athens, Greece, in 430 B.C. Using the writings of Greek historian Thucydides, Kazanjian compared the symptoms, transmission and suspected source of this mystery disease with data reported throughout the ongoing Ebola virus disease outbreak in West Africa.

"Although scholars have postulated typhus, smallpox and even Ebola as possible etiologies, they have been unable to agree on what the retrospective diagnosis might have been in part because limited information about a disease like Ebola has been an obstacle for making comparisons,” Kazanjian wrote in Clinical Infectious Diseases. "New clinical and epidemiologic information now available from today’s large West African epidemic, however, has filled this gap of knowledge about Ebola and permits a more accurate comparison of the Athenian outbreak with Ebola.”

Thucydides documented a summer disease whose symptoms began with abrupt onset of fever, headache, fatigue and stomach pain, but later progressed to vomiting, diarrhea, dehydration, bleeding from the mouth, seizures, hemorrhage and death after 7 to 9 days. The disease was reported to be highly infectious, often being transmitted to physicians or caregivers in close proximity to patients, and was suspected to have originated in "Aethiopia,” the Greek name for regions including sub-Saharan Africa, Sudan and the Democratic Republic of Congo.

Surviving patients were observed as resistant to a second bout of symptoms, suggesting the development of protective immunity, and the deaths of animals alongside humans suggested that the 5-year epidemic also may have had zoonotic qualities.

These details described by Thucydides are consistent with today’s Ebola virus disease, Kazanjian wrote, while the epidemic’s 5-year lifespan and frequent spread in urban areas are within Ebola’s capacity considering the infectivity reported throughout the present-day outbreak.

Compared with other likely infections such as typhus, bubonic plague, anthrax, smallpox, measles and toxic shock syndrome, Ebola was the only disease whose symptoms and epidemiology were able to match the outbreak’s reported characteristics.

"A look back to an ancient outbreak that resembled Ebola on the basis of clinical, epidemiological and geographic similarities shows us how society’s panic-stricken responses to pestilences have intensified the damage and devastation directly caused by the disease itself,” Kazanjian wrote. "From antiquity to medieval times to Ebola today, society’s response of anxiety has worsened the suffering of the individual, disrupted society, marginalized civic or scientific authority, decimated economies and intensified the spread of epidemics. For epidemics today and past, suffering and deprivation has been caused by the idiom of pestilence with its associated fear, flight and isolation as well as by the microbe itself.”

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