Group of infectious diseases
Medical condition
Typhus
, also known as
typhus fever
, is a group of
infectious diseases
that include
epidemic typhus
,
scrub typhus
, and
murine typhus
.
[1]
Common symptoms include fever, headache, and a rash.
[1]
Typically these begin one to two weeks after exposure.
[2]
The diseases are caused by specific types of
bacterial infection
.
[1]
Epidemic typhus is caused by
Rickettsia prowazekii
spread by
body lice
, scrub typhus is caused by
Orientia tsutsugamushi
spread by
chiggers
, and murine typhus is caused by
Rickettsia typhi
spread by
fleas
.
[1]
Vaccines
have been developed, but none are commercially available.
[3]
[4]
[5]
Prevention is achieved by reducing exposure to the organisms that spread the disease.
[3]
[4]
[5]
Treatment is with the antibiotic
doxycycline
.
[2]
Epidemic typhus generally occurs in
outbreaks
when poor sanitary conditions and crowding are present.
[6]
While once common, it is now rare.
[3]
Scrub typhus occurs in
Southeast Asia
,
Japan
, and northern
Australia
.
[4]
Murine typhus occurs in
tropical
and
subtropical
areas of the world.
[5]
Typhus has been described since at least 1528.
[7]
The name comes from the
Greek
tuphos
(
τ?φο?
), meaning hazy or smoky and commonly used as a word for delusion, describing the state of mind of those infected.
[7]
While "typhoid" means "typhus-like", typhus and
typhoid fever
are distinct diseases caused by different types of bacteria.
[8]
Note, however, that in some languages such as
German
, the term
typhus
does mean the "typhoid fever", caused by specific strains of Salmonella typhi bacteria, and the here depicted "typhus" is called lice fever.
Signs and symptoms
[
edit
]
These signs and symptoms refer to epidemic typhus, as it is the most important of the typhus group of diseases.
[9]
Signs and symptoms begin with sudden onset of fever and other flu-like symptoms about one to two weeks after being infected.
[10]
Five to nine days after the symptoms have started, a rash typically begins on the trunk and spreads to the extremities. This rash eventually spreads over most of the body, sparing the face, palms, and soles. Signs of
meningoencephalitis
begin with the rash and continue into the second or third weeks.
[
citation needed
]
Other signs of meningoencephalitis include sensitivity to light (
photophobia
), altered mental status (
delirium
), or coma. Untreated cases are often fatal.
[11]
Signs and symptoms of
scrub typhus
usually start within 1 to 2 weeks after being infected. These symptoms include fever, headaches, chills, swollen lymph nodes, nausea/vomiting, and a rash at the site of infection called an
eschar
. More severe symptoms may damage the lungs, brain, kidney, meninges, and heart.
[12]
Causes
[
edit
]
Multiple diseases include the word "typhus" in their descriptions.
[13]
Types include:
Diagnosis
[
edit
]
The main method of diagnosing typhus of all types is laboratory testing. It is most commonly done with an indirect immunofluorescence antibody IFA test for all types of typhus. This tests a sample for the antibodies associated with typhus. It can also be done with either immunohistochemistry (IHC) or polymerase chain reaction (PCR) tests excluding scrub typhus. Scrub typhus is not tested with IHC or PCR but is instead tested with the IFA test as well as indirect immunuoperoxidase (IIP) assays.
[14]
Prevention
[
edit
]
As of 2024, no vaccine is commercially available.
[3]
[4]
[5]
A vaccine has been in development for scrub typhus known as the
scrub typhus vaccine
.
[15]
Scrub typhus
[
edit
]
Scrub typhus
is caused by mites, so avoid the outdoors when scrub is common in the area. Make sure your clothing is treated with
permethrin
to prevent mite bites. Lastly, make sure to use bug spray to keep mites away as well. For children and babies, you additionally have to make sure their clothing covers their limbs. For babies put a mosquito cover over their stroller which also protects them from mites.
[16]
Epidemic typhus
[
edit
]
Epidemic typhus
is caused by body lice and thrives in areas with overcrowding. To avoid lice you should stay away from highly populated areas. Also, make sure to regularly clean yourself and your clothing to help kill louse. This also goes for things like bedding and towels. Make sure to not share any fabric items with anyone who has lice or typhus. Lastly, treat clothing with
permethrin
because it helps kill lice.
[3]
Murine typhus
[
edit
]
Murine typhus
is caused by flea bites so take steps to avoid fleas. This can be done by making sure pets do not have fleas and if they do, treat them, stay away from wild animals, use insect repellent to keep fleas away, and wear gloves when dealing with sick or dead animals. Take steps to ensure rodents or other wildlife do not get into your home.
[17]
Treatment
[
edit
]
The
American Public Health Association
recommends treatment based upon clinical findings and before culturing confirms the diagnosis.
[18]
Without treatment, death may occur in 10% to 60% of people with epidemic typhus, with people over age 50 having the highest risk of death.
[19]
In the antibiotic era, death is uncommon if
doxycycline
is given. In one study of 60 people hospitalized with epidemic typhus, no one died when given doxycycline or
chloramphenicol
.
[20]
Epidemiology
[
edit
]
According to the
World Health Organization
, in 2010 the death rate from typhus was about one of every 5,000,000 people per year.
[21]
Only a few areas of epidemic typhus exist today. Since the late 20th century, cases have been reported in Burundi, Rwanda, Ethiopia, Algeria, and a few areas in South and Central America.
[22]
[23]
[24]
[25]
Except for two cases, all instances of epidemic typhus in the United States have occurred east of the
Mississippi River
. An examination of a cluster of cases in Pennsylvania concluded the source of the infection was
flying squirrels
.
[26]
Sylvatic cycle
(diseases transmitted from wild animals) epidemic typhus remains uncommon in the US. The
Centers for Disease Control and Prevention
have documented only 47 cases from 1976 to 2010.
[27]
An outbreak of
flea
-borne murine typhus was identified in downtown
Los Angeles, California
, in October 2018.
[28]
History
[
edit
]
Middle Ages
[
edit
]
The first reliable description of typhus appears in 1489 AD during the Spanish siege of
Baza
against the
Moors
during the
War of Granada
(1482?1492). These accounts include descriptions of fever; red spots over arms, back, and chest; attention deficit, progressing to delirium; and
gangrenous
sores and the associated smell of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action, but an additional 17,000 died of typhus.
[29]
In historical times,
[
when?
]
"jail fever" or "gaol fever" was common in English prisons, and is believed by modern authorities to have been typhus. It often occurred when prisoners were crowded together into dark, filthy rooms where lice spread easily. Thus, "imprisonment until the next term of court" was often equivalent to a death sentence. Prisoners brought before the court sometimes infected members of the court.
[30]
The
Black Assize of Exeter 1586
was another notable outbreak. During the Lent assizes court held at
Taunton
in 1730, gaol fever caused the death of the
Lord Chief Baron
, as well as the
High Sheriff
, the sergeant, and hundreds of others. During a time when persons were executed for capital offenses, more prisoners died from 'gaol fever' than were put to death by all the public executioners in the British realm. In 1759, an English authority estimated that each year, a quarter of the prisoners had died from gaol fever.
[30]
In
London
, gaol fever frequently broke out among the ill-kept prisoners of
Newgate Prison
and then moved into the general city population. In May 1750, the
Lord Mayor of London
, Sir
Samuel Pennant
, and many court personnel were fatally infected in the courtroom of the
Old Bailey
, which adjoined Newgate Prison.
[31]
Early modern epidemics
[
edit
]
Epidemics occurred routinely throughout Europe from the 16th to the 19th centuries, including during the
English Civil War
, the
Thirty Years' War
, and the
Napoleonic Wars
.
[32]
Pestilence of several kinds raged among combatants and civilians in
Germany
and surrounding lands from 1618 to 1648. According to Joseph Patrick Byrne, "By war's end, typhus may have killed more than 10 percent of the total German population, and disease in general accounted for 90 percent of Europe's casualties."
[33]
19th century
[
edit
]
During
Napoleon
's
retreat from
Moscow
in 1812, more French soldiers died of typhus than were killed by the Russians.
[34]
A major epidemic occurred in
Ireland
between 1816 and 1819, during the famine caused by a worldwide reduction in temperature known as the
Year Without a Summer
. An estimated 100,000 people perished. Typhus appeared again in the late 1830s, and yet another major typhus epidemic occurred during the
Great Irish Famine
between 1846 and 1849. The typhus outbreak along with
typhoid fever
is said to be responsible for 400,000 deaths.
[35]
The Irish typhus spread to England, where it was sometimes called "Irish fever" and was noted for its virulence. It killed people of all social classes, as lice were endemic and inescapable, but it hit particularly hard in the lower or "unwashed" social strata.
[36]
In the
United States
, a typhus
epidemic
broke out in
Philadelphia
in 1837 and killed the son of
Franklin Pierce
(14th President of the United States) in
Concord, New Hampshire
, in 1843. Several epidemics occurred in
Baltimore
,
Memphis
, and
Washington, DC
, between 1865 and 1873. Typhus was also a significant killer during the
US Civil War
, although
typhoid
fever was the more prevalent cause of US Civil War "camp fever". Typhoid fever is caused by the bacterium
Salmonella enterica Serovar Typhi
.
[37]
In
Canada
alone, the
typhus epidemic of 1847
killed more than 20,000 people from 1847 to 1848, mainly Irish immigrants in
fever sheds
and other forms of quarantine, who had contracted the disease aboard the crowded
coffin ships
in fleeing the
Great Irish Famine
. Officials neither knew how to provide sufficient sanitation under conditions of the time nor understood how the disease spread.
[38]
20th century
[
edit
]
Typhus was
endemic
in
Poland
and several neighboring countries prior to
World War I
(1914?1918), but became
epidemic
during the war.
[39]
[40]
[41]
Delousing stations were established for troops on the
Western Front
during
World War I
, but typhus ravaged the armies of the
Eastern Front
, where over 150,000 died in
Serbia
alone.
[42]
Fatalities were generally between 10% and 40% of those infected and the disease was a major cause of death for those nursing the sick.
[
citation needed
]
In 1922, the typhus epidemic reached its peak in Soviet territory, with some 20 to 30 million cases in
Russia
.
[43]
Although typhus had ravaged
Poland
with some 4 million cases reported, efforts to stem the spread of disease in that country had largely succeeded by 1921 through the efforts of public health pioneers such as
Helene Sparrow
and
Rudolf Weigl
.
[44]
In Russia during the
civil war
between the
White
and
Red Armies
, epidemic typhus killed 2?3 million people, many of whom were civilians.
[41]
[43]
[45]
[46]
In 1937 and 1938 there was a typhus epidemic in
Chile
.
[47]
On March 6th 1939 - French Prime Minister (Daladier) stated to the French parliament, he would return 300,000 of the Spanish refugees fleeing from the 1938 Spanish Civil war). One of the reasons was because of the typhus spread in the French refugee camps amongst other reasons (France's sovereign recognition of Francisco franco)
[48]
During
World War II
, many German POWs after the
loss at Stalingrad
died of typhus. Typhus epidemics killed those confined to POW camps, ghettos, and
Nazi concentration camps
who were held in unhygienic conditions. Pictures of mass graves including people who died from typhus can be seen in footage shot at
Bergen-Belsen concentration camp
.
[49]
Among thousands of prisoners in concentration camps such as
Theresienstadt
and Bergen-Belsen who died of typhus
[49]
were
Anne Frank
, age 15, and her sister
Margot
, age 19 in the latter camp.
The first typhus vaccine was developed by the
Polish
zoologist
Rudolf Weigl
in the interwar period; the vaccine did not prevent the disease but reduced its mortality.
[50]
21st century
[
edit
]
Beginning in 2018, a typhus outbreak spread through
Los Angeles County
primarily affecting homeless people.
[51]
In 2019, city attorney Elizabeth Greenwood revealed that she, too, was infected with typhus as a result of a flea bite
[
dubious
–
discuss
]
at her office in
Los Angeles City Hall
.
[52]
[53]
Pasadena also experienced a sudden uptick in typhus with 22 cases in 2018 but, without being able to attribute this to one location, the Pasadena Public Health Department did not identify the cases as an "outbreak".
[54]
Over the past decade as well murine typhus cases have been rising with the highest number of cases being 171 in 2022.
[55]
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