Created page with "{{Infobox disease | Name = Typhus | Image = Epidemic typhus Burundi.jpg| | Caption = Rash caused by epidemic typhus | DiseasesDB = 29240 | ICD10 = {{ICD10|A|75|1|a|75}} ..."
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{{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 = D014438
}}
'''Epidemic typhus''' (also called "camp fever", "jail fever", "hospital fever", "ship fever", "famine fever", "putrid fever", "petechial fever", "Epidemic louse-borne typhus,"<ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages=1130 |isbn=1-4160-2999-0 }}</ref> 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 |work=}}</ref>) is a form of [[typhus]] 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>{{cite journal |author=Gray MW |title=Rickettsia, typhus and the mitochondrial connection |journal=Nature |volume=396 |issue=6707 |pages=109–10 |date=November 1998 |pmid=9823885 |doi=10.1038/24030 |url=http://www.nature.com/nature/journal/v396/n6707/full/396109a0.html}}</ref><ref>{{cite journal |author=Andersson JO, Andersson SG |title=A century of typhus, lice and Rickettsia |journal=Res. Microbiol. |volume=151 |issue=2 |pages=143–50 |date=March 2000 |pmid=10865960 |doi= 10.1016/s0923-2508(00)00116-9|url=http://linkinghub.elsevier.com/retrieve/pii/S0923-2508(00)00116-9}}</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.
==Signs and symptoms==
Symptoms include severe headache, a sustained high fever, cough, [[rash]], severe [[muscle pain]], [[chills]], falling [[blood pressure]], [[stupor]], [[sensitivity to light]], [[delirium]] and death. A rash begins on the chest about five days after the fever appears, and spreads to the trunk and extremities. A symptom common to all forms of typhus is a fever which may reach 39 °C (102 °F).
[[Brill-Zinsser disease]], first described by [[Nathan Brill]] in 1913 at [[Mount Sinai Hospital, New York|Mount Sinai Hospital]] in [[New York City]], 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 recurrence often occurs in times of relative [[immunosuppression]], which is often in the context of malnutrition and other illnesses. In combination with poor sanitation and hygiene which leads to a greater density of lice, this reactivation is why typhus forms epidemics in times of social chaos and upheaval.
==Transmission==
Epidemic typhus is thus found most frequently during times of war and deprivation. For example, typhus killed hundreds of thousands of prisoners in [[Nazi Germany|Nazi]] [[concentration camp]]s during [[World War II]]. The deteriorating quality of hygiene in camps such as [[Concentration camp Theresienstadt|Theresienstadt]] and [[Bergen-Belsen concentration camp|Bergen-Belsen]] created conditions where diseases such as typhus flourished. Situations in the twenty-first century with potential for a typhus epidemic would include refugee camps during a major famine or natural disaster. In the periods between outbreaks, when human to human transmission occurs less often, the flying squirrel serves as a zoonotic reservoir for the ''Rickettsia prowazekii'' bacterium.
[[Henrique da Rocha Lima]] in 1916 then proved that the bacterium ''Rickettsia prowazekii'' was the agent responsible for typhus; he named it after [[H. T. Ricketts]] and [[Stanislaus von Prowazek]], two zoologists who had died from typhus while investigating epidemics. Once these crucial facts were recognized, [[Rudolf Weigl]] in 1930 was able to fashion a practical and effective vaccine production method<ref>[http://www.lwow.home.pl/Weigl/krynski/teoria.html Weigl's method of intrarectal inoculation of lice in production of typhus vaccine and experimental works with ''Rickettsia Prowazeki'']</ref> 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>{{cite book |author= |title=Nuernberg Military Tribunal |pages=508–511 |volume=I |url=http://www.mazal.org/archive/nmt/01/NMT01-T508.htm}}</ref> This vaccine was widely available and used extensively by 1943.
==Treatment==
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 (close to zero) if intracellular antibiotics such as [[tetracycline]] are used before 8 days. [[Chloramphenicol]] is also used. Infection can also be prevented by vaccination.
==History==
[[Image:CPS141ratpoison.jpg|thumb|upright|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 [[La Trinità della Cava|La Cava abbey]] near [[Salerno]], [[Italy]].<ref>{{cite web |first=Waclaw |last=Szybalski |title=Maintenance of human-fed live lice in the laboratory and production of Weigl's exanthematous typhus vaccine |year=1999 |url=http://www.lwow.home.pl/Weigl.html}}</ref><ref>{{cite book |first=Beppe |last=Carugo |title=Breve Storia della Medicina, della Diagnostica, delle Arti Sanitarie |publisher= |location= |year=2006 |edition=2nd |pages= |url=http://www.qualitologia.it/attivita/27.pdf |format=PDF}}</ref> In 1546, [[Girolamo Fracastoro]], a [[Florentine]] physician, described typhus in his famous treatise on viruses and contagion, ''De Contagione et Contagiosis Morbis''.<ref>{{cite book |last=Fracastoro |first=Girolamo |authorlink=Girolamo Fracastoro |title=De Contagione et Contagiosis Morbis |publisher= |location= |year=1546 }}</ref>
Before a vaccine was developed during World War II, typhus was a devastating disease for humans and has been responsible for a number of [[epidemics]] throughout history.<ref name= Zinsser>{{cite book |last=Zinsser |first=Hans |authorlink=Hans Zinsser |title=Rats, Lice and History: A Chronicle of Pestilence and Plagues |publisher=Black Dog & Leventhal |location=New York |origyear=1935 |year=1996 |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 umm.edu]</ref><ref>{{cite book |authorlink=Arnold Wycombe Gomme |last=Gomme |first=A.W. |editor-first=A. |editor-last=Andrewes |editor2-first=K.J. |editor2-last=Dover |chapter=Volume 5. Book VIII |title=An Historical Commentary on Thucydides |publisher=Oxford University Press |location= |year=1981 |isbn=0-19-814198-X }}</ref>
Typhus also arrived in Europe with soldiers who had been fighting on [[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 stench 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 (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 offences, 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 quarter 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|upright|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 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 Canada, the [[typhus epidemic of 1847]] killed more than 20,000 people died from 1847 to 1848, mainly Irish immigrants in [[fever shed]]s and other forms of quarantine, who had contracted the disease aboard [[coffin ships]].<ref name=mccord1>{{cite web |id=M993X.5.1529.1 |title=The government inspector's office|url=http://www.mccord-museum.qc.ca/en/collection/artifacts/M993X.5.1529.1|work=[[McCord Museum]]|accessdate=22 January 2012|location=[[Montreal]]}}</ref>
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]]. Delousing 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 a [[Russian civil war|civil war]] between the [[White Army|White]] and [[Red Army|Red armies]], typhus killed three million, largely civilians.
During [[World War II]] typhus struck the [[German Army (1935–45)|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 concentration camps|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. 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.
Following the development of a vaccine during World War II, epidemics have usually occurred in [[Eastern Europe]], the [[Middle East]] and parts of Africa, particularly [[Ethiopia]], where its eradication was the focus of major research efforts by [[Naval Medical Research Unit Five]].
==Society and culture==
===Biological weapon===
Typhus was one of more than a dozen agents that the United States researched as potential [[biological weapon]]s before President Richard Nixon suspended all non-defensive aspects of the U.S. biological weapons program in 1969.<ref name=jmcenter>{{cite web |title=Chemical and Biological Weapons: Possession and Programs Past and Present |date=9 April 2002 |publisher=James Martin Center for Nonproliferation Studies |location=[[Middlebury College]] |url=http://cns.miis.edu/research/cbw/possess.htm |accessdate=2008-11-14}}</ref>
===Literature===
{{commons category|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 (novel)|Fathers and Sons]]'' by [[Ivan Turgenev]], Evgeny Bazarov dissects a local peasant and dies after contracting typhus.
* (1886) In the [[short story]] "Excellent People" by [[Anton Chekhov]], typhus kills a [[Russia]]n provincial.
* (1886) In ''The Strange Adventures of Captain Dangerous'' by [[George Augustus Henry Sala]]: "We Convicts were all had to the Grate, for the Knight and Alderman would not venture further in, for fear of the Gaol Fever;"
* (1890) In ''[[How the Other Half Lives]]'' by [[Jacob Riis]], the effects of typhus fever and smallpox on "Jewtown" are described.
* (1922) Lisa, the main character in the novel ''[[Letter from an Unknown Woman]]'' by [[Stefan Zweig]], contracts typhus, along with her son, and she writes her lost love the titular letter from a hospital ward before dying.
* (1940) in ''[[The Don Flows Home to the Sea]]'' by [[Mikhail Sholokhov]], numerous characters contract typhus during the [[Russian Civil War]].
* (1946) In [[Viktor Frankl]]'s ''[[Man's Search for Meaning]]'', Frankl, a Nazi concentration camp prisoner and trained psychiatrist, treats fellow prisoners for delirium due to typhus, whilst being an on-again, off-again sufferer himself.
* (1955) In [[Vladimir Nabokov]]'s ''[[Lolita]]'', Humbert Humbert's childhood sweetheart, Annabel Leigh, dies of typhus.
* (1956) In ''[[Doctor Zhivago (novel)|Doctor Zhivago]]'' by [[Boris Pasternak]], the main character contracts epidemic typhus in the winter following the [[Russian Revolution (1917)|Russian Revolution]], while living in [[Moscow]].
* (1973/1991) In ''[[Maus]]'' by [[Art Spiegelman]], Vladek Spiegelman contracts typhus during his imprisonment at the [[Dachau concentration camp]].
* (c. 1974) In ''[[Little House on the Prairie (TV series)|Little House on the Prairie]]'' (TV series), an outbreak of typhus hits [[Walnut Grove, Minnesota]], killing several. It is traced to below-market-cost [[corn meal]] residents had been purchasing to avoid the high cost of the local [[Mill (grinding)|mill]]. The corn meal had been infested by rats.
* (1978) In [[Patrick O'Brian]]'s novel ''[[Desolation Island (novel)|Desolation Island]]'', an outbreak of "gaol-fever" strikes the crew while sailing aboard the ''Leopard''.
* (1935/2000) [[Hans Zinsser]]'s ''[[Rats, Lice and History]]'', although a touch outdated on the science, contains many useful cross-references to classical and historical impact of typhus.{{citation needed|date=January 2014}}
* (1945) ''[[The Diary of Anne Frank]]'' documents the deaths of Anne and her sister Margot from typhus in [[Bergen-Belsen concentration camp]].
* (1996) In [[Andrea Barrett]]'s novella ''[[Ship Fever]]'', the characters struggle with a typhus outbreak at the Canadian Grosse Isle Quarantine Station during 1847.
* (2004) In [[Neal Stephenson]]'s ''[[The System of the World (novel)|The System Of The World]]'', a fictionalized [[Sir Isaac Newton]] dies of "gaol fever" before being resurrected by [[Daniel Waterhouse]].
* (c. 2001) [[Lynn Morris|Lynn]] and [[Gilbert Morris]]' novel ''[[Where Two Seas Met (novel)|Where Two Seas Met]]'' portrays an outbreak of typhus on the island of Bequia in the Grenadines, in 1869.
* (2009) In ''[[The Last Will and Testament of Zephaniah Mann.]]'', Zephaniah Mann claimed to have contracted "Putrid Fever" in his will.
==See also==
*[[Globalization and disease]]
*[[List of epidemics]]
==References==
{{Reflist|2}}
{{Bacterial diseases}}
{{DEFAULTSORT:Epidemic Typhus}}
[[Category:Bacterium-related cutaneous conditions]]
[[Category:Zoonoses]]
[[Category:Insect-borne diseases]]
[[Category:Biological weapons]]
[[Category:Epidemic typhus]]
{{usedwps}}
[[Category:Rodent-carried diseases]]