typhus

Typhus
Classification and external resources
Rash caused by epidemic typhus
ICD-10	A75.
ICD-9	080-083
DiseasesDB	29240
MedlinePlus	001363
eMedicine	med/2332
MeSH	D014438

Typhus is any of several similar diseases caused by Rickettsiae.^[1] The name comes from the Greek typhos (τῦφος) meaning smoky or hazy, describing the state of mind of those affected with typhus. The causative organism Rickettsia is an obligate parasite and cannot survive for long outside living cells. Typhus should not be confused with typhoid fever, as the diseases are unrelated.

Multiple diseases include the word "typhus" in their description. Types include:

Symptoms

Murine typhus

• Abdominal pain
• Backache
• Dull red rash that begins on the middle of the body and spreads
• Extremely high fever (105-106 degrees Fahrenheit)
• Hacking, dry cough
• Headache
• Joint pain
• Nausea

Epidemic typhus

• Chills
• Cough
• Delirium
• High fever (104 degrees Fahrenheit)
• Joint pain
• Low blood pressure
• Rash
• Sensitivity to light
• Severe headache
• Severe muscle pain
• Stupor

In human history

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

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 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. 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 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.^[3] 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. DDT was used to control the spread of typhus-carrying lice.

Epidemics occurred routinely throughout Europe from the 16th to the 19th centuries, and occurred during the English Civil War, the Thirty Years' War and the Napoleonic Wars. In the Thirty Years' War, an estimated 8 million Germans were wiped out by bubonic plague and typhus fever.^[4].

During Napoleon's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians.^[5]

A major epidemic occurred in Ireland between 1816-19, during the famine caused by a world wide reduction in temperature known as the Year Without a Summer. It is estimated that 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 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, Memphis and Washington DC between 1865 and 1873. 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 fever, caused by Salmonella, is a completely different disease from typhus (see chart below).

During World War I typhus caused three million deaths in Russia and more in Poland and Romania.^[6] 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. Between 1918 and 1922 typhus caused at least 3 million deaths out of 20–30 million cases. In Russia after World War I, during the civil war between the White and 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.

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.^[7] Thousands of prisoners who were held in unsuitable hygiene conditions in Nazi concentration camps such Theresienstadt and Bergen-Belsen also died of typhus during World War II^[7], including Anne Frank at the age of 15 and her sister Margot.

The first successful typhus vaccine was developed by the Polish zoologist Rudolf Weigl in the period between the two world wars.^[8] Better, less dangerous and less expensive vaccines were developed during World War II.

Since then some epidemics have occurred in Eastern Europe, Asia, the Middle East and parts of Africa.

Contemporary Society

According to the UN WHO, typhus continues to kill approximately a weighted average of 0.2 people per million, per annum^[9]. Given a global population of circa 7 billion inhabitants, this equates to a minimum of 1400 deaths per year.

Treatment

Without treatment the disease can be fatal, particularly the epidemic form. Prompt treatment with antibiotics cures nearly every patient.^[10]

• doxycycline
• tetracycline
• chloramphenicol (less common)

References