Orientia tsutsugamushi
"O. tsutsugamushi" causes a complex and dangerous infection scrub typhus. Infection starts when chiggers bite on the skin during their feeding. The bacteria are deposited at the site of feeding (inoculation), where they multiply. They cause progressive tissue damage (necrosis). Necrosis progresses to inflammation of the blood vessels called vasculitis. This in turn causes inflammation of the lymph nodes, called lymphadenopathy. Within a few days, vasculitis extends to various organs including liver, brain, kidney, meninges and the lung. The disease is responsible for nearly a quarter of all the febrile (high fever) illness in endemic areas. Mortality in severe case or due to improper treatment or misdiagnosis may be as high as 30-70%. About 6% of infected people die untreated, and 1.4% of the patients die even with medical treatment. Moreover, death rate can be as high as 13% where medical treatment is not properly handled. In cases of misdiagnosis and failure of treatment, systemic complications rapidly develop including acute respiratory distress syndrome, acute kidney failure, encephalitis, gastrointestinal bleeding, hepatitis, meningitis, myocarditis, pancreatitis, pneumonia, septic shock, sub-acute thyroiditis, and multi-organ dysfunctions. Harmful symptoms involving multiple organ failure and neurological impairment are difficult to treat, and can be lifelong debilitation or directly fatal. The central nervous system is often affected and result in various complications including cerebellitis, cranial nerve palsies, meningoencephalitis, plexopathy, transverse myelitis, neuroleptic malignant syndrome, and Guillan-Barré syndrome. Death rates due to complications can be up to 14% in brain infections, and 24% with multiple organ failure. It is the major cause of acute encephalitis syndrome in India, where viral infection Japanese encephalitis has been regarded as the main factor.
Ellen West
Ellen West’s life was marred by thoughts related to death anxiety. Towards the end of her life, it could be said that she had a death obsession. West was given a great variety of diagnoses including melancholia, severe obsessive neurosis, and schizophrenia. While her major problem dealt with food, as what started out as a diagnosis of anorexia nervosa morphed into bulimia nervosa with the fear of becoming fat through eating. This fixation caused her great depression, as her focus day in and out was on eating or not eating. This "obsession with death" became "life's only goal" and that the "symbolization of life and death took place around the act of eating." West’s fear of becoming fat caused her to welcome death as an acceptable outcome, as then she wouldn’t have to worry anymore. She was often quoted by her psychiatrist, Ludwig Binswanger, explaining how her life felt like a prison that could be only made better by dying. To West, her life felt empty and dull, and filling her body with food only made her feel worse. Filling herself with food actually made her feel empty. It was even suggested that suicide by starvation became her life’s purpose, whereas continuing to feed herself would be equal to committing murder on someone.
This underlying issue of death obsession can be exemplified by other harmful behaviors that she engaged in. West reportedly did several dangerous things to invite illness and death, including riding horse dangerously, kissing children with scarlet fever, and standing outside naked after bathing. Her eventual death came after taking a lethal dose of poison.
West’s psychiatrist Binswanger was quoted as saying, “She looked as she had never looked in life- calm and happy and peaceful.” He thought of her illness as a defense against anxieties which were heightened and overbalanced, but anxieties nonetheless.