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 exposure.
The diseases are caused by specific types of bacterial infection.
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.
There is no commercially available vaccine. Prevention is by
reducing exposure to the organisms that spread the disease.
Treatment is with the antibiotic doxycycline.
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 Australia.
Murine typhus occurs in tropical and subtropical areas of the
Typhus has been described since at least 1528. The name comes from
the Greek typhus (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
1 Signs and symptoms
6.1 Middle Ages
6.2 Gaol Fever
6.3 19th century
6.4 20th century
8 External links
Signs and symptoms
The following 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 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.
Multiple diseases include the word "typhus" in their description.
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 Historical references to "typhus" are now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
Queensland tick typhus or "Australian tick typhus" (and a spotted
As of 2017 there is no commercially available vaccine. A
vaccine has been in development for scrub typhus known as the scrub
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 percent 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 (IV) fluids.
According to the World Health Organization, the current death rate
from typhus is about one out of every 5,000,000 people per year.
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.
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.
See also: Timeline of typhus
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 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. 
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 at
Oxford in 1577, later deemed the Black Assize, over 300 died from gaol
fever, including Sir Robert Bell, Lord Chief Baron of the Exchequer.
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 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.
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 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
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, D.C. 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 did
not know how to provide sufficient sanitation under conditions of the
time, nor understood how the disease spread.
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.
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 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
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,
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 typhus victims' mass graves can be seen in
footage shot at Bergen-Belsen concentration camp.
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
post-war 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 period between the two world wars. 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.
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V · T · D
Patient UK: Typhus
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