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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
Epidemic typhus
is due to Rickettsia prowazekii spread by body lice, scrub typhus is due to Orientia tsutsugamushi
Orientia tsutsugamushi
spread by chiggers, and murine typhus is due to Rickettsia typhi spread by fleas.[1] There is no commercially available vaccine.[3][4][5] Prevention is by reducing exposure to the organisms that spread the disease.[3][5][4] Treatment is with the antibiotic doxycycline.[2] Epidemic
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
Murine typhus
occurs in tropical and subtropical areas of the world.[5] Typhus
Typhus
has been described since at least 1528.[7] The name comes from the Greek typhus (τύφος) meaning hazy, 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]

Contents

1 Signs and symptoms 2 Causes 3 Prevention 4 Treatment 5 Epidemiology 6 History

6.1 Middle Ages 6.2 Gaol Fever 6.3 19th century 6.4 20th century

7 References 8 External links

Signs and symptoms[edit] The following 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. Other signs of meningoencephalitis include sensitivity to light (photophobia), altered mental status (delirium), or coma. Untreated cases are often fatal. Causes[edit] Multiple diseases include the word "typhus" in their description.[11] Types include:

Condition Bacterium Reservoir/vector Notes

Epidemic
Epidemic
louse-borne typhus Rickettsia prowazekii Body louse When the term "typhus" is used without clarification, this is usually the condition described. Historical references to "typhus" are now generally considered to be this condition.[citation needed]

Murine typhus
Murine typhus
or "endemic typhus" Rickettsia typhi Fleas
Fleas
on rats

Scrub typhus Orientia tsutsugamushi Harvest mites on humans or rodents

Queensland tick typhus[12] or "Australian tick typhus" (and a spotted fever[13]) Rickettsia australis Ticks

Prevention[edit] As of 2017 there is no commercially available vaccine.[3][4][5] A vaccine has been in development for scrub typhus known as the scrub typhus vaccine.[14] Treatment[edit] The American Public Health Association
American Public Health Association
recommends treatment based upon clinical findings and before culturing confirms the diagnosis.[15] Without treatment, death may occur in 10 to 60 percent of patients with epidemic typhus, with patients over age 60 having the highest risk of death.[citation needed] In the antibiotic era, death is uncommon if doxycycline is given. In one study of 60 hospitalized patients with epidemic typhus, no patient died when given doxycycline or chloramphenicol.[16] Some patients also may need oxygen and intravenous (IV) fluids. Epidemiology[edit] According to the World Health Organization, the current death rate from typhus is about one out of every 5,000,000 people per year.[17] 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.[18][19][20][21] 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.[22] Sylvatic cycle (diseases transmitted from wild animals) epidemic typhus remains uncommon in the US. The Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
have documented only 47 cases from 1976 to 2010.[23] History[edit] See also: Timeline of typhus Middle Ages[edit]

Civilian Public Service
Civilian Public Service
worker distributes rat poison for typhus control in Gulfport, Mississippi, c. 1945.

The first reliable description of the disease appears in 1489 during the Spanish siege of Baza against the Moors
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; as well as 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. [24] Gaol Fever[edit] In historical times "Gaol Fever", or "Aryotitus fever"[citation needed] 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.[25] Following the assizes held at Oxford
Oxford
in 1577, later deemed the Black Assize, over 300 died from gaol fever, including Sir Robert Bell, Lord Chief Baron of the Exchequer. The Black Assize of Exeter 1586 was another notable outbreak. During the Lent assizes court held at Taunton
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.[25] 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 a large number of court personnel were fatally infected in the courtroom of the Old Bailey, which adjoined Newgate Prison.[26] 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.[27] 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."[28] 19th century[edit] During Napoleon's retreat from Moscow
Moscow
in 1812, more French soldiers died of typhus than were killed by the Russians.[29] A major epidemic occurred in Ireland
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 Irish 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 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. In the United States, a typhus epidemic broke out in Philadelphia
Philadelphia
in 1837 and killed the son of Franklin Pierce
Franklin Pierce
(14th President of the United States) in Concord, New Hampshire, in 1843. Several epidemics occurred in Baltimore, Memphis and Washington, D.C.
Washington, D.C.
between 1865 and 1873. Typhus
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
Typhoid
fever, caused by the bacterium Salmonella typhii (not to be confused with Salmonella enterica, the cause of salmonella food poisoning), is a completely different disease from typhus. 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 did not know how to provide sufficient sanitation under conditions of the time, nor understood how the disease spread.[30] 20th century[edit]

Charles Nicolle
Charles Nicolle
received the 1928 Nobel Prize
Nobel Prize
in Medicine for his identification of lice as the transmitter of epidemic typhus.

A US soldier is demonstrating DDT
DDT
hand-spraying equipment. DDT
DDT
was used to control the spread of typhus-carrying lice.

Delousing stations were established for troops on the Western Front during World War I, but the disease ravaged the armies of the Eastern Front, with over 150,000 dying in Serbia
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. In 1922, the typhus epidemic reached its peak in Soviet territory, with some 25 to 30 million cases in Russia. Although typhus had ravaged Poland
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 Hélène Sparrow and Rudolf Weigl.[31] In Russia, during the civil war between the White and Red Armies, typhus killed 3 million people,[32][33] mainly civilians. During World War II, many German POWs after the loss at Stalingrad died of typhus. Typhus
Typhus
epidemics killed those confined to POW camps, ghettos, and Nazi concentration camps
Nazi concentration camps
who were held in unhygienic conditions. Pictures of typhus victims' mass graves can be seen in footage shot at Bergen-Belsen concentration camp.[34] Among thousands of prisoners in concentration camps such as Theresienstadt and Bergen-Belsen who died of typhus[34] were Anne Frank, age 15, and her sister Margot, age 19. Major epidemics in the post-war chaos of Europe were averted only by widespread use of the newly discovered DDT
DDT
to kill the lice on millions of refugees and displaced persons. The first typhus vaccine was developed by the Polish zoologist Rudolf Weigl in the period between the two world wars.[35] Better, less-dangerous and less-expensive vaccines were developed during World War II. Since then, some epidemics have occurred in Asia, Eastern Europe, the Middle East, and parts of Africa.[citation needed]

References[edit]

^ a b c d e f " Typhus
Typhus
Fevers". www.cdc.gov. 7 March 2017. Archived from the original on 26 March 2017. Retrieved 26 March 2017.  ^ a b c d "Information for Health Care Providers". www.cdc.gov. 7 March 2017. Archived from the original on 27 March 2017. Retrieved 26 March 2017.  ^ a b c d e " Epidemic
Epidemic
Typhus". www.cdc.gov. 7 March 2017. Archived from the original on 26 March 2017. Retrieved 26 March 2017.  ^ a b c d "Scrub Typhus". www.cdc.gov. 7 March 2017. Archived from the original on 26 March 2017. Retrieved 26 March 2017.  ^ a b c d "Murine Typhus". www.cdc.gov. Archived from the original on 26 March 2017. Retrieved 26 March 2017.  ^ "WHO Typhus". www.who.int. May 1997. Archived from the original on 27 March 2017. Retrieved 26 March 2017.  ^ a b Bennett, John E.; Dolin, Raphael; Blaser, Martin J. (2014). Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases E-Book. Elsevier Health Sciences. p. 2217. ISBN 9780323263733. Archived from the original on 2017-09-10.  ^ Evans, Alfred S.; Brachman, Philip S. (2013). Bacterial Infections of Humans: Epidemiology and Control. Springer. p. 839. ISBN 9781461553274. Archived from the original on 2017-09-10.  ^ Levinson, Warren (2010). Review of Medical Microbiology and Immunology (11 ed.). McGraw Hill. ISBN 9780071700283.  ^ Gary R. Mullen; Lance A. Durden (27 September 2002). Medical and Veterinary Entomology. Academic Press. pp. 58–. ISBN 978-0-08-053607-1. Archived from the original on 10 September 2017.  ^ Eremeeva, Marina E; Gregory A Dasch. "Rickettsial (Spotted & Typhus
Typhus
Fevers) & Related Infections ( Anaplasmosis
Anaplasmosis
& Ehrlichiosis)". CDC Centers for Disease Control and Prevention. Archived from the original on 17 May 2014. Retrieved 15 May 2014.  ^ Ticks Factsheet Archived 2011-02-21 at the Wayback Machine. NSW Department of Health ^ Spotted Fevers Archived 2010-12-29 at the Wayback Machine. Department of Medical Entomology, University of Sydney ^ Chattopadhyay, S; Richards, AL (2007). " Scrub typhus
Scrub typhus
vaccines: past history and recent developments". Human
Human
vaccines. 3 (3): 73–80. doi:10.4161/hv.3.3.4009. PMID 17375000.  ^ Heymann, David (2015). Control of communicable diseases manual : an official report of the American Public Health Association. Washington, DC: APHA Press, an imprint of the American Public Health Association. pp. 661–668. ISBN 9780875530185.  ^ MATOSSIAN RM, THADDEUS J, GARABEDIAN GA (1963). "Outbreak of epidemic typhus in the northern region of Saudi Arabia". Am J Trop Med Hyg. 12: 82–90. PMID 13933690. CS1 maint: Multiple names: authors list (link) ^ WHO Statistical Information System (WHOSIS) Archived 2010-02-21 at the Wayback Machine. ^ Raoult, D (1997). "Jail fever (epidemic typhus) outbreak in Burundi". Emerg Infect Dis. 3 (3): 357–60. doi:10.3201/eid0303.970313. PMC 2627627 . PMID 9284381.  ^ Mokrani (2004). "Reemerging threat of epidemic typhus in Algeria". J Clin Microbiol. 42 (8): 3898–900. doi:10.1128/jcm.42.8.3898-3900.2004. PMC 497610 . PMID 15297561.  ^ " Epidemic typhus
Epidemic typhus
risk in Rwandan refugee camps". Wkly Epidemiol Rec. 69 (34): 259. 1994. PMID 7947074.  ^ Perine, PL (1992). "A clinico-epidemiological study of epidemic typhus in Africa". Clin Infect Dis. 14 (5): 1149–58. doi:10.1093/clinids/14.5.1149. PMID 1600020.  ^ Chapman, A (2009). "Cluster of sylvatic epidemic typhus cases associated with flying squirrels, 2004–2006". Emerg Infect Dis. 15 (7): 1005–11. doi:10.3201/eid1507.081305. PMC 2744229 . PMID 19624912.  ^ McQuiston, JH (2010). "Brill-Zinsser disease in a patient following infection with sylvatic epidemic typhus associated with flying squirrels". Clin Infect Dis. 51 (6): 712–5. doi:10.1086/655891. PMID 20687836.  ^ zinsser, hans (1960). rats, lice and history. Bantam Classic. p. 186.  ^ a b Ralph D. Smith, "Comment, Criminal Law—Arrest—The Right to Resist Unlawful Arrest", 7 NAT. RESOURCES J. 119, 122 n.16 (1967) (hereinafter Comment) (citing John Howard, The State of Prisons 6–7 (1929)) (Howard's observations are from 1773 to 1775). Copied from State v. Valentine (May 1997) 132 Wn.2d 1, 935 P.2d 1294 ^ Gordon, Charles The Old Bailey
Old Bailey
and Newgate Archived 2016-03-12 at the Wayback Machine. pp.331–2. T. Fisher Unwin, London, 1902 ^ War and Pestilence Archived 2009-09-21 at the Wayback Machine.. Time magazine ^ Byrne, Joseph Patrick (2008). Encyclopedia of Pestilence, Pandemics, and Plagues: A—M. ABC-CLIO. p. 732. ISBN 0-313-34102-8. Archived from the original on 2014-01-04.  ^ The Historical Impact of Epidemic
Epidemic
Typhus
Typhus
Archived 2009-11-14 at WebCite. Joseph M. Conlon. ^ "M993X.5.1529.1 The government inspector's office". McCord Museum. Montreal. Archived from the original on 8 April 2011. Retrieved 22 January 2012.  ^ Paul Weindling. International Health Organisations and Movements, 1918–1939. Cambridge University Press
Cambridge University Press
1995, p. 99. ^ Andrew W. Artenstein. Vaccines: A Biography. Springer 2010, p. 250 ^ David G. Rempel. A Mennonite Family in Tsarist Russia
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and the Soviet Union, 1789–1923. University of Toronto Press 2011, p. 249 ^ a b "Trials of War Criminals Before the Nurenberg Military Tribunal" (PDF). Volumn 1. US. Government Printing Office. 1949. pp. 508–511. Archived (PDF) from the original on 4 March 2016. Retrieved 19 May 2015.  ^ Naomi Baumslag, Murderous Medicine: Nazi Doctors, Human Experimentation, and Typhus, Greenwood Publishing Group, 2005, page 133 Archived 2014-06-27 at the Wayback Machine.

External links[edit]

Classification

V · T · D

ICD-10: A75 ICD-9-CM: 080–083 MeSH: D014438 DiseasesDB: 29240

External resources

MedlinePlus: 001363 eMedicine: med/2332 Patient UK: Typhus

v t e

Infectious diseases Bacterial disease: Proteobacterial G−

primarily A00–A79, 001–041, 080–109

α

Rickettsiales

Rickettsiaceae/ (Rickettsioses)

Typhus

Rickettsia typhi

Murine typhus

Rickettsia prowazekii

Epidemic
Epidemic
typhus, Brill–Zinsser disease, Flying squirrel typhus

Spotted fever

Tick-borne

Rickettsia rickettsii

Rocky Mountain spotted fever

Rickettsia conorii

Boutonneuse fever

Rickettsia japonica

Japanese spotted fever

Rickettsia sibirica

North Asian tick typhus

Rickettsia australis

Queensland tick typhus

Rickettsia honei

Flinders Island spotted fever

Rickettsia africae

African tick bite fever

Rickettsia parkeri

American tick bite fever

Rickettsia aeschlimannii

Rickettsia aeschlimannii infection

Mite-borne

Rickettsia akari

Rickettsialpox

Orientia tsutsugamushi

Scrub typhus

Flea-borne

Rickettsia felis

Flea-borne spotted fever

Anaplasmataceae

Ehrlichiosis: Anaplasma phagocytophilum

Human
Human
granulocytic anaplasmosis, Anaplasmosis

Ehrlichia chaffeensis

Human
Human
monocytotropic ehrlichiosis

Ehrlichia ewingii

Ehrlichiosis ewingii infection

Rhizobiales

Brucellaceae

Brucella abortus

Brucellosis

Bartonellaceae

Bartonellosis: Bartonella henselae

Cat-scratch disease

Bartonella quintana

Trench fever

Either B. henselae or B. quintana

Bacillary angiomatosis

Bartonella bacilliformis

Carrion's disease, Verruga peruana

β

Neisseriales

M+

Neisseria meningitidis/meningococcus

Meningococcal disease, Waterhouse–Friderichsen syndrome, Meningococcal septicaemia

M−

Neisseria gonorrhoeae/gonococcus

Gonorrhea

ungrouped:

Eikenella corrodens/Kingella kingae

HACEK

Chromobacterium violaceum

Chromobacteriosis infection

Burkholderiales

Burkholderia pseudomallei

Melioidosis

Burkholderia mallei

Glanders

Burkholderia cepacia complex Bordetella pertussis/Bordetella parapertussis

Pertussis

γ

Enterobacteriales (OX−)

Lac+

Klebsiella pneumoniae

Rhinoscleroma, Klebsiella pneumonia

Klebsiella granulomatis

Granuloma inguinale

Klebsiella oxytoca

Escherichia coli: Enterotoxigenic Enteroinvasive Enterohemorrhagic O157:H7 O104:H4

Hemolytic-uremic syndrome

Enterobacter aerogenes/Enterobacter cloacae

Slow/weak

Serratia marcescens

Serratia infection

Citrobacter koseri/Citrobacter freundii

Lac−

H2S+

Salmonella enterica

Typhoid
Typhoid
fever, Paratyphoid fever, Salmonellosis

H2S−

Shigella dysenteriae/sonnei/flexneri/boydii

Shigellosis, Bacillary dysentery

Proteus mirabilis/Proteus vulgaris Yersinia pestis

Plague/Bubonic plague

Yersinia enterocolitica

Yersiniosis

Yersinia pseudotuberculosis

Far East scarlet-like fever

Pasteurellales

Haemophilus:

H. influenzae

Haemophilus
Haemophilus
meningitis Brazilian purpuric fever

H. ducreyi

Chancroid

H. parainfluenzae

HACEK

Pasteurella multocida

Pasteurellosis Actinobacillus

Actinobacillosis

Aggregatibacter actinomycetemcomitans

HACEK

Legionellales

Legionella pneumophila/Legionella longbeachae

Legionnaires' disease

Coxiella burnetii

Q fever

Thiotrichales

Francisella tularensis

Tularemia

Vibrionaceae

Vibrio cholerae

Cholera

Vibrio vulnificus Vibrio parahaemolyticus Vibrio alginolyticus Plesiomonas shigelloides

Pseudomonadales

Pseudomonas aeruginosa

Pseudomonas infection

Moraxella catarrhalis Acinetobacter baumannii

Xanthomonadaceae

Stenotrophomonas maltophilia

Cardiobacteriaceae

Cardiobacterium hominis

HACEK

Aeromonadales

Aeromonas hydrophila/Aeromonas veronii

Aeromonas infection

ε

Campylobacterales

Campylobacter jejuni

Campylobacteriosis, Guillain–Barré syndrome

Helicobacter pylori

Peptic ulcer, MALT lymphoma, Gastric cancer

Helicobacter cinaedi

Helicobacte

.