Typhus is any one of several similar diseases caused by louse-borne bacteria. The name comes from the Greek typhos, meaning
smoky or lazy, describing the state of mind of those affected with typhus. Rickettsia is endemic in rodent hosts,
including mice and rats, and spreads to humans through mites, fleas and body lice. The arthropod vector flourishes under conditions of poor hygiene, such as
those found in prisons 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.
Types of typhus
itchiness.
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 fleas that
infest rats. [1]
Less often, endemic typhus is caused by Rickettsia felis and transmitted by fleas carried
by cats or possums. Symptoms of endemic typhus include
headache, fever, chills, myalgia, nausea,
vomiting, and cough. Endemic typhus is highly treatable with
antibiotics.[1] Most people recover fully, but
death may occur in the elderly, severely disabled or patients with a depressed immune system.
Scrub typhus
Scrub typhus (also called "chigger-borne typhus") is caused by Orientia tsutsugamushi and transmitted by chiggers, which are found
in areas of heavy scrub vegetation. Symptoms include fever, headache, muscle pain, cough, and gastrointestinal symptoms. More virulent strains of O. tsutsugamushi can cause
hemorrhaging and intravascular
coagulation.
Vaccine
The first major step in the development of the vaccine was Charles Nicolle's 1909 discovery that lice were the 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.[2]
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 guts 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-ready method using egg
yolks was developed by Herald R. Cox in 1938.[3] This vaccine was used heavily by 1943.
History
The first description of typhus was probably given in 1083 at a convent near Salerno, Italy.[4] In 1546, Girolamo
Fracastoro, a Florentine physician, described typhus in his famous treatise on viruses
and contagion, De Contagione et Contagiosis Morbis.[5]
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.[6] These epidemics tend to follow wars, famine, and other conditions that result in mass
causalties.
During the second year of the Peloponnesian War (430
BC), the city-state of 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 one of the strongest candidates for the cause of
this disease outbreak, supported by both medical and scholarly opinions.[7][8]
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 Lord Chief
Baron of the Exchequer. The outbreak that followed, between 1557 to 1559, killed about 10% of the English population. 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 realm. In 1759 an English authority estimated that each year a
fourth of the prisoners had died from Gaol fever.[9] 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 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 French
soldiers died of typhus than were killed by the Russians. 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, 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 20–30 million
cases. In Russia after World War I, during a 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.
During World War II typhus struck the German army
as it invaded Russia in 1941.[3] In 1942 and 1943
typhus hit French North Africa, Egypt and
Iran particularly hard.[10]
Typhus epidemics killed inmates in the Nazi Germany concentration camps, infamous pictures of typhus victims' mass graves could be seen in footage shot at
Bergen-Belsen concentration camp.[3] Thousands of prisoners held in appalling conditions in Nazi concentration camps such Theresienstadt and
Bergen-Belsen also died of typhus during World War II[3], including Anne
Frank and her sister Margot.
Following the development of a vaccine during World War II epidemics occur only in Eastern
Europe, the Middle East and parts of Africa.
Cultural references
Wikimedia Commons has media related to:
- (1847) In Jane Eyre by Charlotte Bronte, an
outbreak of typhus occurs in Jane's school Lowood, highlighting the unsanitary conditions the girls live in.
- (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.
References
- ^ a b Information on Murine Typhus (Fleaborne Typhus) or Endemic Typhus Texas Department of
State Health Services (2005).
- ^ Gross, Ludwik (1996) 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.
- ^ a b c d Nuernberg Military Tribunal, Volume I pp. 508-511
- ^ Maintenace of human-fed live lice in the laboratory and production of Weigl's exanthematous typhus vaccine by Waclaw
Szybalski (1999)
- ^ Fracastoro, Girolama, De
Contagione et Contagiosis Morbis (1546).
- ^ 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.
- ^ At a January 1999 medical conference at the 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
- ^ 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.
- ^ 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
- ^ Zarafonetis, Chris J. D. Internal
Medicine in World War II, Volume II, Chapter 7
|
Bacterial diseases (primarily A00-A79, 001-041,080-109) |
| G+/Firmicutes |
Clostridium
(Pseudomembranous colitis, Botulism,
Tetanus, Gas gangrene) - Streptococcus A and B
(Scarlet fever, Erysipelas) - Staphylococcus (Toxic shock syndrome) -
Bacilli (Anthrax, Listeriosis) |
| G+/Actinobacteria |
Mycobacterium: Tuberculosis (Ghon
focus, Ghon's complex, Tuberculous
meningitis, Pott's disease, Scrofula,
Bazin disease, Lupus vulgaris, Miliary tuberculosis) - Leprosy - Lady Windermere syndrome - Buruli ulcer -
Actinomycetales: Actinomycosis -
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(Sodoku) - Leptospirosis |
| G-/Chlamydiae |
Chlamydia
- Lymphogranuloma venereum - Psittacosis -
Trachoma |
| G-/α Proteobacteria |
Rickettsioses
(Typhus, Scrub typhus, Rocky Mountain spotted fever, Boutonneuse fever,
Q fever, Trench fever, Rickettsialpox) - Brucellosis - Cat scratch fever - Bartonellosis (Bacillary angiomatosis) |
| G-/β&γ Proteobacteria |
Salmonella (Typhoid fever, Paratyphoid fever, Salmonellosis) - other intestinal
(Cholera, Shigellosis) - Zoonotic (Bubonic plague, Tularemia, Glanders, Melioidosis,
Pasteurellosis) - Other: Pertussis -
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