Robert Koch: From Cholera to Sleeping Sickness

Xi: Welcome back everyone.

Class: Good morning professor Xi!

I hope everyone had a good weekend. Today we are continuing our lesson on Robert Koch. Just to recap for everyone here: Robert Koch was a physician who saw patients in his home. He also had his own makeshift lab where he studied microbiology. It was in this lab that he discovered the existence of Anthracis bacillus, the microbe that can cause Anthrax. After his finding, Koch was offered a more prestigious position as the health officer in Berlin where he got a government-funded laboratory. It was in this lab that the discovery of agar was made. This was a huge discovery as it is the fundamental way the Giants still try to grow us and research us today! But during his time, it was his research on Tuberculosis that made him world-famous.

Now, today it's your turn to tell me about Robert Koch’s research! Anna, will tell us about Koch and his involvement with Cholera?

Anna: Ok, but let me say that he was not the giant that found that microbe, but he got the glory for over 80 years. Sounds like a no-good lying ass…..

Xi: Don’t finish that statement or you will have a week's detention. Remember, the information did not travel as readily as it does today.

Anna: Ok, I'll bite my spike protein. I was going to say assuming giant, but I guess I’ll just start.

In 1883, an outbreak of the diarrheal disease cholera broke out in Egypt. Both France and Germany sent scientists to work on it and Koch headed the German team. However, soon after they had arrived, the outbreak subsided. But Koch, being the overachiever he was, wanted to continue studying the disease, so he got permission from the German government to go to India and study this it further. Like for reals, who wants to do extra work, what a waste of time! There, he was able to see the microbe, finding it in the intestines of the sick, but not in those that were healthy. Koch was also able to isolate it and look at it under a microscope, noting that it was crescent-shaped, calling it comma bacilli. He also found that bad sewage conditions were spreading the disease, finding the microbe in the contaminated well water; he also found that the use of disinfectants helped prevent the spread.

Although Koch did not find a cure, guess he wasn’t that much of an overachiever, after all, he went back to Germany and presented his findings. Not everyone believed him, including Max Joseph von Pettenkofer who was known for his work in practical hygiene as well as epidemiology on cholera and typhus. To disprove Koch, this dummy drank a culture of cholera and said he had only a mild stomach ache! Despite this, most believed Koch’s results, which lead to new sanitation laws.

Like I said earlier, Koch was not the first person to discover the bacterium Vibrio cholera, he just was the one that got all the credit. The giant is soooo bad at giving credit where credit is due. The real hero of this story is not Robert Koch or the dummy that drank Cholera, but Filippo Pacini, an Italian scientist. It was in 1854 during a cholera pandemic that Filippo viewed the deceased intestinal mucosa under the microscope, seeing the comma-shaped bacilli. That year, he published a paper on it tying Vibrio cholerae to the disease. Later on, he correctly found the disease was due to a massive loss of fluid and electrolytes due to the microbes' action on the intestines and suggested IV therapy for the most extreme cases, a practice that is true and still used today. But despite all this, the scientific community, being the stuck up bas--

Xi: Watch it, Anna!

Ugh…whatever, they ignored his findings and Koch got all the glory, for a while that is. In 1965 the International Committee on Nomenclature ruled that Filippo was indeed the first to discover it, posthumously giving him the recognition he deserved. Perusal the Giants were only like a million generations late on that one.

Xi: Thank you, Anna, that was a very good report, very informative.

Chloe: Hey, how come I could not present that one?

Xi: Because doing a report on yourself is too easy and doesn't allow you to learn about new topics. Now Larry, please talk to us about Tuberculin.

Larry: Ok, but I would like to call this the Tuberculin Debacle.

Anna: A bit dramatic don’t you think?

Larry: Maybe, but that makes the topic more fun.

Moving forward to 1885, Robert Koch became the head of the Hygienic Institute and full professor at the University of Berlin. It was at this time that Koch continued his research with Cholera. He found that injecting guinea pigs with the microbe under the skin would cause an ulcer and sickness, but a subsequent injection showed improved health, a possible sign that he may have found a vaccine. Further research led him to discover something called tuberculin, a protein found in the microbe and in the liquid of dead Mycobacterium tuberculosis. Initial results were promising for Koch’s vaccine, but there was a conference coming up and he was getting a lot of pressure to present his results. He was not comfortable with this as he only had preliminary results and felt that he needed the whole picture before he showed the world his research, but reluctantly he was pushed to do so. Oddly, it seemed everyone had already heard the news, and before getting up to speak the MC said Koch “had an injection that killed the disease.”

Myckey: Hey….I’m….not….a….disease….just….misunderstood.

Larry: I know sorry, I'm just quoting what they said.

When Koch spoke, he was very careful to say that he was conducting research and that there had been promising results in guinea pigs, but he had not yet finished his research and encouraged everyone at the conference to still look for a cure. However, the world wouldn't listen.

Around the world, the giants wanted this tuberculin “miracle,” but it ended up not being an effective vaccine and doctors were overdosing patients. This caused resentment that was pointed straight at Koch. He had to publish a statement about tuberculin saying the following:

• That it must be injected under the skin

• The giants can withstand only a fraction of what was given to guinea pigs

• It will not help in advanced cases

• The injection should be performed under controlled conditions.

The vaccine ended up being a flop, but tuberculin still had uses for the giants. They found that it could be used as a diagnostic tool for giants that had been exposed to the microbe. This is done by injecting the tuberculin under the skin and waiting a couple of days; if they had been exposed to the microbe prior, they would have an immune reaction causing inflammation in the area of the injection while no inflammation meant they had not been exposed. Despite the disastrous result, Koch would try to find new tuberculin in hopes of finding a vaccine for the infection for the rest of his life.

Xi: Very good. I would like to add a little bit about his life at this time, for those that like dramas like “The Real Protozoa of the Pond'' might be interested in. This occurred a couple of years before Koch’s tuberculin discovery. In 1890, Koch and his wife were growing apart, their daughter had married and moved away and Koch was growing more involved with his research, or so it seems. That same year he met another woman, Frauhein Freiberg.

Class: OOOOOOOO!

Xi: Now, not much is known, but Koch and his wife divorced in 1893. Two months later, though, he married Fraunhein.

Anna: So Scandalous.

Xi: Indeed, so much so that friends of his refused to talk to him. Despite all this, The two would be married till his death. She even went on expeditions with him despite getting Malaria on multiple occasions. Oh, but we should get back to the presentations. Mia It is your time to present.

Mia: Ok, now Koch didn’t necessarily make any microbiology discoveries, but he did further the treatment of malaria.

Malaria is the result of a plasmodium parasite infecting the giants and multiplies in red blood cells; when they multiply enough the plasmodium then bursts out. This was first theorized by Alphonse Lauron, one of Koch’s proteges, and later received a Nobel prize for proving it. This can cause fever, chills, anemia and fatigue in the giants which can become deadly. Surprisingly, malaria is caused by multiple microbes, 5 in fact.

These microbes are transmitted by a genus of mosquito called Anopheles and, at the time of Robert Koch, science at least knew that transmission was by this vector. Koch went to Africa in 1896 for another expedition, but ended up doing some work on the disease. At the time, there was a medication to treat it, Quinine, but it was being misused and could actually bring on symptoms of the disease if used improperly.

Koch was able to work out a more effective treatment with the medication at the time. You see, the disease goes through different stages and Koch was able to figure out a more effective dosing regimen as well as what stage to implement it. He also developed a blood test to determine if someone had the plasmodium and what stage they were in. Sorry Professor Xi, that his presentation is a little short, I couldn’t really find any more information no matter how hard I tried. I guess this was just not one of the bigger events in his life.

Xi: That's ok you still did a great job, as always Mia. Alright, now time for our last presentation, Larry can you please talk about African Sleeping Sickness?

Larry: Well, it was during this time in 1905 that Robert Koch was awarded the Nobel Prize in Physiology or Medicine for his work on Tuberculosis. The following year he went to study Sleeping Sickness in Eastern Africa; this is caused by a protozoan called a trypanosome and is transmitted by the tsetse fly. The manifestations of the disease could take years to develop, so during that time a giant could be unknowingly transmitting the protozoa to others. This is due to them being bitten by the fly that takes up the microbe via a blood meal, flying to another giant and infecting them through biting. During his time in Africa, Koch discovered that the disease usually went through 3 stages:

1. Protozoa could be found in the blood and the patient had a high fever

2. The throat and neck glands would swell

3. The microbe invaded the brain and could be found in the cerebral spinal fluid, the afflicted couldn’t mover certain muscles sleeping for long periods and eventually never wake up

This disease is almost 100% fatal to the giants. In fact, on one island Koch visited, Sleeping sickness was largely responsible for the drop in the giant's population with 15,000 inhabitants left of the original 35,000. Unknown to the scientific community at the time, the reason why the disease progresses is that the protozoa are great at evading the immune system. The microbe is covered in variant surface glycoproteins or sugar-protein molecules, and the immune system recognizes these molecules and will start to mount a defense. but the microbe will change these molecules making that the immune system doesn’t recognize and needs to mount a new defense. Eventually, the protozoa is too far ahead of the immune system leading to death.

Besides identifying stages, Koch also suggested that the local government destroy the breeding ground of the fly, which in my opinion is completely uncalled for but who knows why the giants do what they do. He also suggested treating early stages with Atoxyl or a preparation made with arsenic an extremely toxic chemical to the giants. But for some reason they really liked using it in medicine.

In addition, Koch developed a blood test to determine the stage of infection and a treatment plan of how much medicine to give and when. With his intervention, the death rate of the giants was cut by 90%.

Xi: Very good thank you, Larry, glad you did your research this time.

Larry: Well, I do need to pass this class, so putting the effort into this one should just get me there.

Xi: That is very disappointing to hear, maybe detention will make you view the situation a little differently.

Larry: Awww, come on!

Xi: Well, you could always repeat it.

Larry: No, no, I'll be here after classes today.

Xi: Good. Now, Robert Koch was involved with much more than what we can cover in today's class including a treatment for Cattle Plague in 1896 with a 75% success rate, and contributed to the research on Leprosy, Blackwater Fever, Surra Sickness and Texas Fever. But he was getting older at this point and traveled more. He did develop a heart condition that eventually led to his death in 1910, but it was peaceful as he was watching the sunset.

Psydney: I think we all wish we could all go that peacefully, not by antimicrobials.

Julian: Yeah that's how I lost my mom.

Xi: Indeed that would be nice. Alright, a class that brings us to the end of our lectures on Robert Koch. Next class, we will have our midterm so make sure to Study up on both Koch and Pasteur.

Class: Bye Professor Xi!

The majority of the information in this blog was provided by the book Robert Koch Father of Microbiology by David C. Knight published in 1961.