WASHINGTON: What killed ancient conqueror Alexander the Great is still a mystery, pitting scientists who favor West Nile virus against those who lean toward a death from typhoid.
History says Alexander, king of Macedonia, died at 32 in 323 BC after several days of fever in Babylon. However, the cause of the fever was always unclear.
Many hypotheses have been advanced: poisoning, malaria or cirrhosis of the liver, as well as typhoid or West Nile virus.
The dispute resurfaced in the July issue of "Emerging Infectious Diseases," published by the Centers for Disease Control and Prevention, which published several arguments disputing the West Nile virus theory.
In a December 2003 article in the same publication, two US scientists, John Marr, epidemiologist at the Virginia Department of Health, and Charles Calisher of Colorado State University, argued that Alexander's death as recounted by Greek biographer Plutarch centuries later showed that he had encephalitis from West Nile virus.
The virus infects wild birds but can be transmitted to humans by infected mosquitoes. The infection generally goes undetected or has influenza-like symptoms. In some cases, the disease becomes complicated by a menengoencephalitis.
Marr and Calisher lean on Plutarch's account of the deaths of a flock of ravens as Alexander entered Babylon.
David Oldach, University of Maryland School of Medicine, Baltimore, said Plutarch never meant to write a history, and Marr and Calisher were "perhaps unaware of the magnitude of Plutarch's obsession with avian auguries." Six years ago, Oldach wrote that Alexander died of typhoid - based on symptoms described by Plutarch.
Burke Cunha, of Winthrop-University Hospital in Mineola, New York, also has his doubts.
"Fevers are not usually the most conspicuous feature of West Nile encephalitis, and in most cases the fever does not usually increase or last more than two weeks. ... Alexander's final illness is more characteristic of typhoid fever."
Finally, Massimo Galli, of Milan University, Italy, said: "Encephalitis itself became a frequent complication of West Nile virus fever in 1996, suggesting the recent appearance of more pathogenic viral strains."
The dispute should get a new life in a few months, with the release of a film on Alexander by US director Oliver Stone.