Typhus 46177 220263115 2008-06-19T00:55:17Z Kea2 6747464 /* Endemic typhus */ added possible misdiagnoses {{Infobox_Disease | Name = Typhus | Image = Epidemic typhus Burundi.jpg| | Caption = Rash caused by Epidemic typhus. | DiseasesDB = 29240 | ICD10 = {{ICD10|A|75|1|a|75}} | ICD9 = {{ICD9|080}}-{{ICD9|083}} | ICDO = | OMIM = | MedlinePlus = 001363 | eMedicineSubj = med | eMedicineTopic = 2332 | MeshID = }} {{dablink|For the unrelated disease caused by [[Salmonella typhi]], see [[Typhoid fever]]. For the unrelated disease caused by [[Salmonella paratyphi]], please refer to [[Paratyphoid fever]]. For the monster of [[Greek mythology]], see [[Typhus (monster)]].}} '''Typhus''' is any of several similar [[disease]]s caused by [[louse]]-borne bacteria. The name comes from the [[Greek language|Greek]] ''typhos'', meaning smoky or lazy, describing the state of mind of those affected with typhus. The causative organism ''[[Rickettsia]]'' is an obligate [[parasite]] and cannot live long outside living cells. Rickettsia is [[endemic]] in rodent hosts, including mice and rats, and spreads to humans through mites, fleas and body lice. The [[arthropod]] [[vector (biology)|vector]] flourishes under conditions of poor hygiene, such as those found in prisons, concentration camps, or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field. In [[tropical]] countries, typhus is often mistaken for [[dengue fever]]. Most rickettsial diseases include the word "typhus" in their description, however related diseases include [[Rocky Mountain spotted fever]] and "spotted fevers" endemic in Colombia and Brazil. ==Types of typhus== ===Epidemic typhus=== Epidemic typhus (also called "Jail Fever", "Hospital Fever", "Ship fever", "Famine fever", "Petechial Fever", and "louse-borne typhus")<ref>{{cite web |url=http://www.sedgleymanor.com/diseases/diseases_p-t.html |title=Diseases P-T at sedgleymanor.com |accessdate=2007-07-17 |format= |work=}}</ref> is 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 corporis'').<ref>Gray, Michael W. [http://www.nature.com/nature/journal/v396/n6707/full/396109a0.html Rickettsia, typhus and the mitochondrial connection] Nature 396, 109 - 110 ([[12 November]] [[1998]])].</ref><ref>Jan O. Andersson, Siv G.E. Andersson, “A century of typhus, lice, and Rickettsia” , Res. Microbiol. 151 (2000) 143–150.</ref> Feeding on a human who carries the bacillus 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. Typhus will eventually kill the louse, though the disease will remain viable for many weeks in the dead louse. Symptoms include severe headache, a sustained high fever, cough, [[rash]], severe [[muscle pain]], [[chills]], falling [[blood pressure]], [[stupor]], [[sensitivity to light]], and [[delirium]]. A rash begins on the chest about five days after the fever appears, and spreads to the trunk and extremities but does not reach the face, palms and soles. A symptom common to all forms of typhus is a fever which may reach 39°C (102°F). The infection is treated with [[antibiotics]]. Intravenous fluids and [[oxygen]] may be needed to stabilize the patient. The mortality rate is 10% to 60%, but is vastly lower if antibiotics such as [[tetracycline]] are used early. Infection can also be prevented via vaccination. Brill-Zinsser disease 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 type of recurrence can also occur in [[immunosuppression|immunosuppressed]] patients. Epidemic typhus is found most frequently during times of war and privation. For example, typhus killed many thousands of prisoners in [[Nazi Germany]] [[concentration camp]]s during [[World War II]]. The abysmally low standards of hygiene enforced in camps such as [[Concentration camp Theresienstadt|Theresienstadt]] and [[Bergen-Belsen concentration camp|Bergen-Belsen]] created conditions where diseases such as typhus flourished. A possible modern scenario for typhus epidemics would be in refugee camps during a major famine or natural disaster. This form of typhus is also known as "prison fever" or "ship fever", because it becomes prevalent in crowded conditions in prisons and aboard ships. ===Endemic typhus=== Endemic typhus (also called "flea-borne typhus" and "murine typhus" or "rat flea typhus") is caused by the bacteria ''[[Rickettsia typhi]]'', and is transmitted by the [[flea]]s that infest [[rat]]s. <ref name=Texas>[http://www.dshs.state.tx.us/idcu/disease/murine_typhus/information/ Information on Murine Typhus (Fleaborne Typhus) or Endemic Typhus] Texas Department of State Health Services (2005).</ref> Less often, endemic typhus is caused by ''[[Rickettsia felis]]'' and transmitted by fleas carried by cats or [[opossum]]s. Symptoms of endemic typhus include headache, fever, chills, [[myalgia]], [[nausea]], [[vomiting]], and cough. Endemic typhus is highly treatable with antibiotics.<ref name=Texas/> Most people recover fully, but death may occur in the elderly, severely disabled or patients with a depressed immune system. Symptoms may resemble those of [[measles]], [[rubella]], or possibly [[Rocky Mountain spotted fever]].<ref> ''Current Medical Dianosis & Treatment 1999'' ed. Lawrence M. Tierney, Jr., MD, Stephen J. McPhee, MD, Maxine A. Papadakis, MD, Appleton & Lange, 1999. pp.1286 ISBN 0-8385-1550-9</ref> ===Scrub typhus=== [[Scrub typhus]] (also called "chigger-borne typhus") is caused by ''[[Orientia tsutsugamushi]]'' and transmitted by [[Harvest mite|chigger]]s, which are found in areas of heavy scrub vegetation. This variety of typhus was known in Japan as ''tsutsugamushi disease'', hence the formal name, and was also prevalent in [[Malaysia]] and [[Australia]]. According to J. R. Audy, severe epidemics of the disease occurred among troops in what was then known as [[Burma]] and [[Ceylon]] during the [[World War II]]. Symptoms include fever, headache, muscle pain, cough, and [[gastrointestinal]] symptoms. More virulent strains of ''O. tsutsugamushi'' can cause [[hemorrhaging]] and [[intravascular coagulation]]. Contact with species related to the chigger mite, found in many parts of the world, can also cause an intense irritation of the human skin. ==Vaccine== The first major step in the development of the [[vaccine]] was [[Charles Nicolle]]'s 1909 discovery that [[lice]] were the [[Vector (biology)|vectors]] for epidemic typhus. This made it possible to isolate the bacteria causing the disease and develop a vaccine; he was awarded the 1928 [[Nobel Prize in Physiology or Medicine]] for this work. Nicolle attempted a vaccine but was not successful in making one that worked on a large enough scale.<ref>Gross, Ludwik (1996) [http://www.pnas.org/cgi/reprint/93/20/10539.pdf ''How Charles Nicolle of the Pasteur Institute discovered that epidemic typhus is transmitted by lice: reminiscences from my years at the Pasteur Institute in Paris''] Proc. Natl. Acad. Sci. Vol. 93, pp. 10539-10540.</ref> [[Henrique da Rocha Lima]] in 1916 then proved that the bacteria ''Rickettsia prowazekii'' was the agent responsible for typhus; he named bacteria after [[H. T. Ricketts]] and [[Stanislaus von Prowazek]], two zoologists who died investigating a typhus epidemic in a prison camp in 1915. Once these crucial facts were recognized, [[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|mass-production]]-ready method using [[egg yolk]]s was developed by [[H. R. Cox|Herald R. Cox]] in 1938.<ref name =Mazal1>[http://www.mazal.org/archive/nmt/01/NMT01-T508.htm ''Nuernberg Military Tribunal, Volume I''] pp. 508-511</ref> This vaccine was widely available and used extensively by 1943. ==History== [[Image:CPS141ratpoison.jpg|thumb|right|[[Civilian Public Service]] worker distributes rat poison for typhus control in [[Gulfport, Mississippi]], ca. 1945.]] The first description of typhus was probably given in 1083 at a convent near [[Salerno]], [[Italy]].<ref>[http://www.lwow.home.pl/Weigl.html Maintenance of human-fed live lice in the laboratory and production of Weigl's exanthematous typhus vaccine] by Waclaw Szybalski (1999)</ref> In 1546, [[Girolamo Fracastoro]], a [[Florentine]] physician, described typhus in his famous treatise on viruses and contagion, ''De Contagione et Contagiosis Morbis''.<ref>[[Girolamo Fracastoro|Fracastoro, Girolama]], ''De Contagione et Contagiosis Morbis'' (1546).</ref> Before a vaccine was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of [[epidemics]] throughout history.<ref name= Zinsser>[[Hans Zinsser|Zinsser, Hans]]. ''Rats, Lice and History: A Chronicle of Pestilence and Plagues''. Originally published in Boston in 1935, later edition in 1963. Most recent edition 1996, Black Dog & Leventhal Publishers, New York. ISBN 1-884822-47-9.</ref> 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 [[History of Athens|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.<ref>At a January 1999 medical conference at the [[University of Maryland, College Park|University of Maryland]], Dr. David Durack, consulting professor of medicine at [[Duke University]] notes: ''"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. The Plague of Athens had all these features."'' see also: http://www.umm.edu/news/releases/athens.html</ref><ref>Gomme, A. W., edited by A. Andrewes and K. J. Dover. ''An Historical Commentary on Thucydides, Volume 5. Book VIII'' Oxford University Press, 1981. ISBN 0-19-814198-X.</ref> Typhus also arrived in Europe with soldiers who had been fighting on the isle of [[Cyprus]]. The first reliable description of the disease appears during the Spanish siege of [[Moorish]] [[Granada]] in 1489. These accounts include descriptions of fever and red spots over arms, back and chest, progressing to delirium, gangrenous sores, and the stink of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action but an additional 17,000 died of typhus. Typhus was also common in prisons (and in crowded conditions where lice spreads 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 (Knight)|Sir Robert Bell]] Lord Chief Baron of the Exchequer. The outbreak that followed, between 1577 to 1579, killed about 10% of the [[English people|English]] population. During the Lent [[Assize Court]] held at [[Taunton]] (1730) typhus caused the death of the [[Lord Chief Baron of the Exchequer|Lord Chief Baron]], as well as the [[High Sheriff of Somerset|High Sheriff]], the sergeant, and hundreds of others. During a time when there were 241 capital offenses--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 fourth of the prisoners had died from Gaol fever.<ref>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</ref> In [[London]], typhus frequently broke out among the ill-kept prisoners of [[Newgate Gaol]] and then moved into the general city population. [[Image:DDT WWII soldier.jpg|thumb|left|A U.S. soldier is demonstrating DDT-hand spraying equipment. DDT was used to control the spread of typhus-carrying lice.]] Epidemics occurred throughout Europe from the 16th to the 19th centuries, and occurred during the [[English Civil War]], the [[Thirty Years' War]] and the [[Napoleonic Wars]]. During [[Napoleon]]'s retreat from [[Moscow]] in 1812, more [[France|French]] soldiers died of typhus than were killed by the [[Russia]]ns. A major epidemic occurred in [[Ireland]] between 1816-19, and 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, since lice were endemic and inescapable, but it hit particularly hard in the lower or "unwashed" social strata. In America, a typhus epidemic killed the son of [[Franklin Pierce]] in [[Concord, New Hampshire]] in 1843 and struck in [[Philadelphia]] in 1837. Several epidemics occurred in [[Baltimore, Maryland|Baltimore]], [[Memphis, Tennessee|Memphis]] and [[Washington DC]] between 1865 and 1873. Typhus fever 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 is a completely different disease from typhus. During [[World War I]] typhus caused three million deaths in Russia and more in [[Poland]] and [[Romania]]. De-lousing 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 to 40 percent of those infected, and the disease was a major cause of death for those nursing the sick. Some historians assert that the disease may serve as a model for the use of biological weapons while in the field. Between 1918 and 1922 typhus caused at least 3 million deaths out of 20&ndash;30 million cases. In Russia after World War I, during a civil war between the [[White Army|White]] and [[Red Army|Red armies]], typhus killed three million, largely civilians. 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. During World War II typhus struck the [[German army]] as it invaded Russia in 1941.<ref name =Mazal1/> In 1942 and 1943 typhus hit [[French North Africa]], [[Egypt]] and [[Iran]] particularly hard.<ref>Zarafonetis, Chris J. D. [http://history.amedd.army.mil/booksdocs/wwii/infectiousdisvolii/chapter7.htm ''Internal Medicine in World War II, Volume II'', Chapter 7] </ref> 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.<ref name =Mazal1/> Thousands of prisoners held in appalling conditions in [[Nazi]] concentration camps such Theresienstadt and Bergen-Belsen also died of typhus during World War II<ref name =Mazal1/>, including [[Anne Frank]] at the age of 15 and her sister Margot. Following the development of a vaccine during World War II, epidemics usually occurred in [[Eastern Europe]], the [[Middle East]] and parts of Africa. ==Cultural references== {{commonscat|Typhus}} * (1847) In ''[[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 due to contracting typhus. * (1886) In the [[short story]] ''Excellent People'' by [[Anton Chekhov]], typhus kills a [[Russia]]n provincial. * (1890) In ''[[How the Other Half Lives]]'' by [[Jacob Riis]], the effects of typhus fever and small-pox on "Jewtown" are described. * (1955) In [[Vladimir Nabokov]] 's ''[[Lolita]]'', Humbert Humbert's childhood sweetheart, Annabel Leigh, dies of typhus. * (c. 1974) In ''[[Little House on the Prairie]]'' (TV series), an outbreak of typhus hits [[Walnut Grove]] 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) [[Patrick O'Brian|O'Brian, Patrick]]. ''[[Desolation Island]]'' Fictional presentation of typhus - while sailing aboard the ''Leopard'' an outbreak of 'gaol-fever' strikes the crew. ==References== {{Reflist|2}} * Audy, J. R. "Red Mites and Typhus." London: The Athlone Press. 1968. ISBN 0485263181 * May, Jacques M. "Maps of the World - Distribution of Rickettsial Diseases." Geographical Review, Vol. 44, No. 1 (January, 1954) pp. 133-136. {{Bacterial diseases}} [[Category:Bacterial diseases]] [[Category:Zoonoses]] [[Category:Insect-borne diseases]] [[Category:Biological weapons]] [[Category:Rickettsiales]] [[Category:Rat carried diseases]] [[bg:Тиф]] [[de:Fleckfieber]] [[da:Plettyfus]] [[es:Tifus]] [[eo:tifo]] [[fr:Typhus]] [[it:Tifo]] [[he:טיפוס הבהרות]] [[ms:Tifus]] [[nl:Vlektyfus]] [[ja:チフス]] [[pl:Tyfus plamisty]] [[pt:Tifo]] [[ru:Тиф]] [[sr:Тифус]] [[fi:Pilkkukuume]] [[sv:Tyfus]] [[tr:Tifo]] [[uk:Тиф]] [[zh:斑疹傷寒]]