Typhus, also known as typhus fever, is a group of infectious diseases
that include epidemic typhus, scrub typhus, and murine
typhus. Common symptoms include fever, headache, and a
rash. Typically these begin one to two weeks after
The diseases are caused by specific types of bacterial
Epidemic typhus is due to Rickettsia prowazekii
spread by body lice, scrub typhus is due to Orientia tsutsugamushi
spread by chiggers, and murine typhus is due to Rickettsia typhi
spread by fleas.
Currently no vaccine is commercially
available. Prevention is by reducing
exposure to the organisms that spread the
disease. Treatment is with the
Epidemic typhus generally occurs in
outbreaks when poor sanitary conditions and crowding are
present. While once common, it is now rare.
Scrub typhus occurs in Southeast Asia, Japan, and northern
Murine typhus occurs in tropical and subtropical
areas of the world.
Typhus has been described since at least 1528 AD. The name
comes from the Greek tûphos (τύφος) meaning hazy, describing the
state of mind of those infected. While "typhoid" means
"typhus-like", typhus and typhoid fever are distinct diseases caused
by different types of bacteria.
1 Signs and symptoms
6.1 Middle Ages
6.2 Gaol Fever
6.3 19th century
6.4 20th century
6.5 21st century
8 External links
Signs and symptoms
These signs and symptoms refer to epidemic typhus, as it is the most
important of the typhus group of diseases.
Signs and symptoms begin with sudden onset of fever, and other
flu-like symptoms about one to two weeks after being
infected. Five to 9 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
Multiple diseases include the word "typhus" in their
descriptions. Types include:
Epidemic louse-borne typhus
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 Historical references to "typhus" are now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.
Murine typhus or "endemic typhus"
Fleas on rats
Harvest mites on humans or rodents
Rickettsia spotted fever group
Includes Boutonneuse fever, Rocky Mountain spotted fever, Queensland
tick typhus and other variants.
As of 2019, no vaccine is commercially
available. A vaccine has been in
development for scrub typhus known as the scrub typhus
American Public Health Association
American Public Health Association recommends treatment based upon
clinical findings and before culturing confirms the
diagnosis. Without treatment, death may occur in 10 to 60%
of patients with epidemic typhus, with patients over age 60 having the
highest risk of death. 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. Some patients also may
need oxygen and intravenous fluids.
According to the World Health Organization, the current death rate
from typhus is about one of every 5,000,000 people per
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
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.
Sylvatic cycle (diseases
transmitted from wild animals) epidemic typhus remains uncommon in the
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention have documented
only 47 cases from 1976 to 2010. An outbreak of flea-borne
typhus was identified in downtown
Los Angeles, California
Los Angeles, California in October
2018 that was larger than their usual number of typhus
See also: Timeline of typhus
The first reliable description of the disease 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.
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. Following the assizes held
Oxford in 1577, later deemed the Black Assize, over 300 died from
gaol fever, including Sir Robert Bell, Lord Chief Baron of 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.
In London, gaol fever frequently broke out among the ill-kept
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
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. 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
During Napoleon's retreat from
Moscow in 1812, more French soldiers
died of typhus than were killed by the Russians.
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 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
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
Typhus was also a significant killer during the US Civil War,
although typhoid fever was the more prevalent cause of US Civil War
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
neither knew how to provide sufficient sanitation under conditions of
the time nor understood how the disease spread.
The clipper Ticonderoga was infamous for her "fever ship" voyage
from Liverpool to Port Phillip carrying 795
passengers in 1852. The overcrowded ship was not designed well for
passenger carrying, sanitary provisions were inadequate, and the
ship's doctors were soon overwhelmed. During the voyage, 100
passengers died of what was later determined to have been
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
Yugoslavia alone. Fatalities were
generally between 10 and 40% 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
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. In
Russia during the civil war
between the White and Red Armies, typhus killed 3 million
people, mainly civilians.
During World War II, many German POWs after the loss at Stalingrad
died of typhus.
Typhus epidemics killed those confined to POW camps,
Nazi concentration camps
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
Among thousands of prisoners in concentration camps such as
Theresienstadt and Bergen-Belsen who died of typhus were
Anne Frank, age 15, and her sister Margot, age 19. Major epidemics in
the postwar chaos of Europe were averted only by widespread use of the
DDT to kill the lice on millions of refugees and
The first typhus vaccine was developed by the Polish zoologist Rudolf
Weigl in the interwar period. 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.
Charles Nicolle received the 1928
Nobel Prize in Medicine for his
identification of lice as the transmitter of epidemic typhus.
A US soldier is demonstrating
DDT hand-spraying equipment.
used to control the spread of typhus-carrying lice.
Civilian Public Service
Civilian Public Service worker distributes rat poison for typhus
control in Gulfport, Mississippi, around 1945.
Beginning in 2018, a typhus outbreak of more than the usual number of
cases has spread through
Los Angeles County
Los Angeles County primarily affecting
homeless people. In 2019, city attorney Elizabeth
Greenwood revealed that she, too, was infected with typhus as a result
of a flea bite at her office in Los Angeles City Hall, which resulted
in her going on medical leave.
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ClassificationDICD-10: A75 ICD-9-CM: 080–083MeSH: D014438DiseasesDB:
29240External resourcesMedlinePlus: 001363eMedicine: med/2332Patient
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,
.mw-parser-output .nobold font-weight:normal ungrouped:
Eikenella corrodens/Kingella kingae
Burkholderia cepacia complex
Bordetella pertussis/Bordetella parapertussis
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