Epidemic typhus is a form of typhus so named because the disease often
causes epidemics following wars and natural disasters. The causative
organism is Rickettsia prowazekii, transmitted by the human body louse
(Pediculus humanus humanus).
1 Signs and symptoms
6 Society and culture
6.1 Biological weapon
Poverty and displacement
7 See also
9 External links
Signs and symptoms
Symptoms include severe headache, a sustained high fever, cough, rash,
severe muscle pain, chills, falling blood pressure, stupor,
sensitivity to light, delirium and death. A rash begins on the chest
about five days after the fever appears, and spreads to the trunk and
extremities. A symptom common to all forms of typhus is a fever which
may reach 39 °C (102 °F).
Brill-Zinsser disease, first described by
Nathan Brill in 1913 at
Mount Sinai Hospital in New York City, is a mild form of epidemic
typhus which recurs in someone after a long period of latency (similar
to the relationship between chickenpox and shingles). This recurrence
often occurs in times of relative immunosuppression, which is often in
the context of malnutrition and other illnesses. In combination with
poor sanitation and hygiene which leads to a greater density of lice,
this reactivation is why typhus forms epidemics in times of social
chaos and upheaval.
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Feeding on a human who carries the bacterium infects the louse. R.
prowazekii grows in the louse's gut and is excreted in its feces. The
disease is then transmitted to an uninfected human who scratches the
louse bite (which itches) and rubs the feces into the wound. The
incubation period is one to two weeks. R. prowazekii can remain viable
and virulent in the dried louse feces for many days.
eventually kill the louse, though the disease will remain viable for
many weeks in the dead louse.
Epidemic typhus has historically occurred during times of war and
deprivation. For example, typhus killed hundreds of thousands of
Nazi concentration camps
Nazi concentration camps during World War II. The
deteriorating quality of hygiene in camps such as Auschwitz,
Theresienstadt, and Bergen-Belsen created conditions where diseases
such as typhus flourished. Situations in the twenty-first century with
potential for a typhus epidemic would include refugee camps during a
major famine or natural disaster. In the periods between outbreaks,
when human to human transmission occurs less often, the flying
squirrel serves as a zoonotic reservoir for the Rickettsia prowazekii
Henrique da Rocha Lima
Henrique da Rocha Lima in 1916 proved that the bacterium Rickettsia
prowazekii was the agent responsible for typhus; he named it after H.
T. Ricketts and Stanislaus von Prowazek, two zoologists who had died
from typhus while investigating epidemics. Once these crucial facts
Rudolf Weigl in 1930 was able to fashion a practical
and effective vaccine production method by grinding up the insides
of infected lice that had been drinking blood. It was, however, very
dangerous to produce, and carried a high likelihood of infection to
those who were working on it.
A safer mass-production-ready method using egg yolks was developed by
Herald R. Cox in 1938. This vaccine was widely available and used
extensively by 1943.
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IFA, ELISA or PCR positive after 10 days
The infection is treated with antibiotics. Intravenous fluids and
oxygen may be needed to stabilize the patient. There is a significant
disparity between the untreated mortality and treated mortality rates:
10-60% untreated versus close to 0% treated with antibiotics within 8
days of initial infection. Tetracycline, Chloramphenicol, and
doxycycline are commonly used.
Infection can also be prevented by
Some of the simplest methods of prevention and treatment focus on
preventing infestation of body lice. Complete change of clothing,
washing the infested clothing in hot water, and in some cases also
treating recently used bedsheets all help to prevent typhus by
removing potentially infected lice. Clothes also left unworn and
unwashed for 7 days also cause both lice and their eggs to die, as
they have no access to their human host. Another form of lice
prevention requires dusting infested clothing with a powder consisting
of 10% DDT, 1% malathion, or 1% permethrin, which kill lice and their
Rash caused by epidemic typhus in Burundi
The first description of typhus was probably given in 1083 at La Cava
abbey near Salerno, Italy. In 1546, Girolamo Fracastoro, a
Florentine physician, described typhus in his famous treatise on
viruses and contagion, De Contagione et Contagiosis Morbis.
Before a vaccine was developed during World War II, typhus was a
devastating disease for humans and has been responsible for a number
of epidemics throughout history. These epidemics tend to follow
wars, famine, and other conditions that result in mass casualties.
During the second year of the
Peloponnesian War (430 BC), the
city-state of Athens in ancient
Greece was hit by a devastating
epidemic, known as the Plague of Athens, which killed, among others,
Pericles and his two elder sons. The plague returned twice more, in
429 BC and in the winter of 427/6 BC.
Epidemic typhus is a strong
candidate for the cause of this disease outbreak, supported by both
medical and scholarly opinions.
Typhus also arrived in Europe with soldiers who had been fighting on
Cyprus. The first reliable description of the disease appears during
the Spanish siege of
Granada in 1489. These accounts include
descriptions of fever and red spots over arms, back and chest,
progressing to delirium, gangrenous sores, and the stench of rotting
flesh. During the siege, the Spaniards lost 3,000 men to enemy action
while an additional 17,000 died of typhus.
Typhus was also common in prisons (and in crowded conditions where
lice spread easily), where it was known as Gaol fever or Jail fever.
Gaol fever often occurs when prisoners are frequently huddled together
in dark, filthy rooms. Imprisonment until the next term of court was
often equivalent to a death sentence. It was so infectious that
prisoners brought before the court sometimes infected the court
itself. Following the
Assize held at
Oxford in 1577, later deemed the
Black Assize, over 300 died from epidemic typhus, including Sir Robert
Bell, Lord Chief Baron of the Exchequer. The outbreak that followed,
between 1577 and 1579, killed about 10% of the English population.
During the Lent
Assize Court held at
Taunton (1730) typhus caused the
death of the Lord Chief Baron, as well as the High Sheriff, the
sergeant, and hundreds of others. During a time when there were 241
capital offences, more prisoners died from 'gaol fever' than were put
to death by all the public executioners in the realm. In 1759 an
English authority estimated that each year a quarter of the prisoners
had died from gaol fever. In London, typhus frequently broke out
among the ill-kept prisoners of
Newgate Gaol and then moved into the
general city population.
A U.S. soldier is demonstrating DDT-hand spraying equipment.
used to control the spread of typhus-carrying lice.
Epidemics occurred throughout Europe and occurred during the English
Civil War, the
Thirty Years' War
Thirty Years' War and the Napoleonic Wars. During
Napoleon's retreat from
Moscow in 1812, more of his soldiers died of
typhus than were killed by the Russians. A major epidemic occurred in
Ireland between 1816–19, and again in the late 1830s, while yet
another major typhus epidemic occurred during the Great Irish Famine
between 1846 and 1849. 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, since lice were endemic and
inescapable, but it hit particularly hard in the lower or "unwashed"
social strata. In Canada, 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 coffin ships.
In America, a typhus epidemic killed the son of
Franklin Pierce in
Concord, New Hampshire
Concord, New Hampshire in 1843 and struck in
Philadelphia in 1837.
Several epidemics occurred in Baltimore, Memphis and Washington, D.C.
between 1865 and 1873.
Typhus fever was also a significant killer
during the American Civil War, although typhoid fever was the more
prevalent cause of US Civil War "camp fever."
Typhoid is a completely
different disease from typhus.
Physician, anthropologist, historian Rudolph Carl Virchow’s attempt
to control an outbreak of typhus in Upper Silesia and his subsequent
190 page report included the observation that the solution to the
outbreak did not lie in individual treatment or small changes in
housing, food or clothing provided, but rather in widespread
structural changes that directly addressed the issue of poverty.
Virchow’s experience in Upper Silesia led to the observation that
“Medicine is a social science”. His report led to changes in
German public health policy.
World War I
World War I typhus caused three million deaths in
Poland and Romania. Delousing stations were established for
troops on the Western front but the disease ravaged the armies of the
Eastern front, with over 150,000 dying in Serbia alone. Fatalities
were generally between 10 and 40 percent of those infected, and the
disease was a major cause of death for those nursing the sick. Between
1918 and 1922 typhus caused at least 3 million deaths out of 20–30
million cases. In
Russia after World War I, during a civil war between
the White and Red armies, typhus killed three million, largely
World War II
World War II typhus struck the German Army as it
Russia in 1941. In 1942 and 1943 typhus hit French North
Iran particularly hard.
Typhus epidemics killed
inmates in the
Nazi Germany concentration camps; infamous pictures of
typhus victims' mass graves can be seen in footage shot at
Bergen-Belsen concentration camp. Thousands of prisoners held in
appalling conditions in
Nazi concentration camps
Nazi concentration camps such as Auschwitz,
Theresienstadt, and Bergen-Belsen also died of typhus during World War
Anne Frank at the age of 15 and her sister Margot.
Even larger epidemics in the post-war chaos of Europe were only
averted by the widespread use of the newly discovered
DDT to kill the
lice on millions of refugees and displaced persons.
Following the development of a vaccine during World War II, epidemics
have usually occurred in Eastern Europe, the
Middle East and parts of
Africa, particularly Ethiopia, where its eradication was the focus of
major research efforts by Naval Medical Research Unit Five.
In one of its first major outbreaks since World War II, epidemic
typhus reemerged in 1995 in a jail in N’Gozi, Burundi. This outbreak
followed the outbreak of a civil war in 1993 that caused the
displacement of 760,000 people.
Refugee camps were crowded and
unsanitary, often far from towns and medical services.
A 2005 study found discovered seroprevalence of R. prowazekii
antibodies in homeless populations in two shelters in Marseille,
France, noting the “hallmarks of epidemic typhus and relapsing
Society and culture
Typhus was one of more than a dozen agents that the United States
researched as potential biological weapons before President Richard
Nixon suspended all non-defensive aspects of the U.S. biological
weapons program in 1969.
Poverty and displacement
The CDC lists the following areas as active foci of human epidemic
typhus: Andean regions of South America, some parts of Africa; on the
other hand, the CDC only recognizes an active enzootic cycle in the
United States involving flying squirrels (CDC). Though epidemic typhus
is commonly thought to be restricted to areas of the developing world,
serological examination of homeless persons in Houston found evidence
for exposure to the bacterial pathogens that cause epidemic typhus and
murine typhus. A study involving 930 homeless people in Marseilles,
France found high rates of seroprevalence to R. prowazekii and a high
prevalence of louse-borne infections in the homeless.
Typhus has been increasingly discovered in homeless populations in
Typhus among homeless populations is especially
prevalent as these populations tend to migrate across states and
countries, spreading the risk of infection with their movement. The
same risk applies to refugees, who travel across country lines, often
living in close proximity and unable to maintain necessary hygienic
standards to avoid being at risk for catching lice possibly infected
Because the typhus-infected lice live in clothing, the prevalence of
typhus is also affected by weather, humidity, poverty and lack of
hygiene. Lice, and therefore typhus, are more prevalent during colder
months, especially winter and early spring. In these seasons, people
tend to wear multiple layers of clothing, giving lice more places to
go unnoticed by their hosts. This is particularly a problem for
poverty-stricken populations as they often do not have multiple sets
of clothing, preventing them from practicing good hygiene habits that
could prevent louse infestation.
Due to fear of an outbreak of epidemic typhus, the US Government put a
typhus quarantine in place in 1917 across the entirety of the
US-Mexican border. Sanitation plants were constructed that required
immigrants to be thoroughly inspected and bathed before crossing the
border. Those who routinely crossed back and forth across the border
for work were required to go through the sanitation process weekly,
updating their quarantine card with the date of the next week’s
sanitation. These sanitation border stations remained active over the
next two decades, regardless of the disappearance of the typhus
threat. This fear of typhus and resulting quarantine and sanitation
protocols dramatically hardened the border between the US and Mexico,
fostering scientific and popular prejudices against Mexicans. This
ultimately intensified racial tensions and fueled efforts to ban
immigrants to the US from the Southern Hemisphere because the
immigrants were associated with the disease.
Wikimedia Commons has media related to Typhus.
Jane Eyre by Charlotte Brontë, an outbreak of typhus occurs
in Jane's school Lowood, highlighting the unsanitary conditions the
girls live in.
(1862) In Fathers and Sons by Ivan Turgenev, Evgeny Bazarov dissects a
local peasant and dies after contracting typhus.
(1886) In the short story "Excellent People" by Anton Chekhov, typhus
kills a Russian provincial.
(1886) In The Strange Adventures of Captain Dangerous by George
Augustus Henry Sala: "We Convicts were all had to the Grate, for the
Knight and Alderman would not venture further in, for fear of the Gaol
How the Other Half Lives
How the Other Half Lives by Jacob Riis, the effects of
typhus fever and smallpox on "Jewtown" are described.
(1922) Lisa, the main character in the novel Letter from an Unknown
Woman by Stefan Zweig, contracts typhus, along with her son, and she
writes her lost love the titular letter from a hospital ward before
The Don Flows Home to the Sea by Mikhail Sholokhov, numerous
characters contract typhus during the Russian Civil War.
(1946) In Viktor Frankl's Man's Search for Meaning, Frankl, a Nazi
concentration camp prisoner and trained psychiatrist, treats fellow
prisoners for delirium due to typhus, whilst being an on-again,
off-again sufferer himself.
(1955) In Vladimir Nabokov's Lolita, Humbert Humbert's childhood
sweetheart, Annabel Leigh, dies of typhus.
(1956) In Doctor Zhivago by Boris Pasternak, the main character
contracts epidemic typhus in the winter following the Russian
Revolution, while living in Moscow.
Maus by Art Spiegelman, Vladek Spiegelman contracts
typhus during his imprisonment at the Dachau concentration camp.
(c. 1974) In Little House on the Prairie (TV series), an outbreak of
typhus hits Walnut Grove, Minnesota, killing several. It is traced to
below-market-cost corn meal residents had been purchasing to avoid the
high cost of the local mill. The corn meal had been infested by rats.
(1978) In Patrick O'Brian's novel Desolation Island, an outbreak of
"gaol-fever" strikes the crew while sailing aboard the Leopard.
(1935/2000) Hans Zinsser's Rats,
Lice and History, although a touch
outdated on the science, contains many useful cross-references to
classical and historical impact of typhus.
(1945) The Diary of
Anne Frank documents the deaths of Anne and her
sister Margot from typhus in Bergen-Belsen concentration camp.
(1996) In Andrea Barrett's novella Ship Fever, the characters struggle
with a typhus outbreak at the Canadian Grosse Isle Quarantine Station
(2004) In Neal Stephenson's The System Of The World, a fictionalized
Sir Isaac Newton
Sir Isaac Newton dies of "gaol fever" before being resurrected by
(c. 2001) Lynn and Gilbert Morris' novel Where Two Seas Met portrays
an outbreak of typhus on the island of Bequia in the Grenadines, in
(2009) In The Last Will and Testament of Zephaniah Mann., Zephaniah
Mann claimed to have contracted "Putrid Fever" in his will.
Globalization and disease
List of epidemics
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Epidemic typhus fever is the best explanation. It hits hardest
in times of war and privation, it has about 20 percent mortality, it
kills the victim after about seven days, and it sometimes causes a
striking complication: gangrene of the tips of the fingers and toes.
Plague of Athens
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V · T · D
Bacterial disease: Proteobacterial G−
primarily A00–A79, 001–041, 080–109
Epidemic typhus, Brill–Zinsser disease,
Flying squirrel typhus
Rocky Mountain spotted fever
Japanese spotted fever
North Asian tick typhus
Queensland tick typhus
Flinders Island spotted fever
African tick bite fever
American tick bite fever
Rickettsia aeschlimannii infection
Flea-borne spotted fever
Ehrlichiosis: Anaplasma phagocytophilum
Human granulocytic anaplasmosis, Anaplasmosis
Human monocytotropic ehrlichiosis
Ehrlichiosis ewingii infection
Bartonellosis: Bartonella henselae
Either B. henselae or B. quintana
Carrion's disease, Verruga peruana
Meningococcal disease, Waterhouse–Friderichsen syndrome,
Eikenella corrodens/Kingella kingae
Burkholderia cepacia complex
Bordetella pertussis/Bordetella parapertussis
Rhinoscleroma, Klebsiella pneumonia
Escherichia coli: Enterotoxigenic
Enterobacter aerogenes/Enterobacter cloacae
Citrobacter koseri/Citrobacter freundii
Typhoid fever, Paratyphoid fever, Salmonellosis
Shigellosis, Bacillary dysentery
Proteus mirabilis/Proteus vulgaris
Far East scarlet-like fever
Brazilian purpuric fever
Legionella pneumophila/Legionella longbeachae
Aeromonas hydrophila/Aeromonas veronii
Campylobacteriosis, Guillain–Barré syndrome
Peptic ulcer, MALT lymphoma, Gastric cancer