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Typhus

Typhus

Definition

Several different illnesses are called "typhus," all of them caused by one of the bacteria in the family Rickettsiae. Each illness occurs when the bacteria is passed to a human through contact with an infected insect.

Description

The four main types of typhus are:

  • epidemic typhus
  • Brill-Zinsser disease
  • endemic or murine typhus
  • scrub typhus

These diseases are all somewhat similar, although they vary in terms of severity. The specific type of Rickettsia that causes the disease also varies, as does the specific insect that can pass the bacteria along.

Epidemic typhus, which is sometimes called jail fever or louse-borne typhus, is caused by Rickettsia prowazekii, which is carried by body lice. When the lice feed on a human, they may simultaneously defecate. When the person scratches the bite, the feces (which carrys the bacteria) are scratched into the wound. Body lice are common in areas in which people live in overcrowded, dirty conditions, with few opportunities to wash themselves or their clothing. Because of this fact, this form of typhus occurs simultaneously in large numbers of individuals living within the same community; that is, in epidemics. This type of typhus occurs when cold weather, poverty, war, and other disasters result in close living conditions that encourage the maintenance of a population of lice living among humans. Some medical historians think that the Great Plague of Athens in 430 B.C. may have been epidemic typhus. Epidemic typhus is now found in the mountainous regions of Africa, South America, and Asia.

Brill-Zinsser disease is a reactivation of an earlier infection with epidemic typhus. It affects people years after they have completely recovered from epidemic typhus. When something causes a weakening of their immune system (like aging, surgery, illness), the bacteria can gain hold again, causing illness. This illness tends to be extremely mild.

Endemic typhus is carried by fleas. When a flea lands on a human, it may defecate as it feeds. When the person scratches the itchy spot where the flea was feeding, the bacteria-laden feces are scratched into the skin, thus causing infection. The causative bacteria is called Rickettsia typhi. Endemic typhus occurs most commonly in warm, coastal regions. In the United States, southern Texas and southern California have the largest number of cases.

Scrub typhus is caused by Rickettsia tsutsugamushi. This bacteria is carried by mites or chiggers. As the mites feed on humans, they deposit the bacteria. Scrub typhus occurs commonly in the southwest Pacific, southeast Asia, and Japan. It is a very common cause of illness in people living in or visiting these areas. It occurs more commonly during the wet season.

Causes and symptoms

The four types of typhus cause similar types of illnesses, though varying in severity.

Epidemic typhus causes fever, headache, weakness, and muscle aches. It also causes a rash composed of both spots and bumps. The rash starts on the back, chest, and abdomen, then spreads to the arms and legs. The worst types of complications involve swelling in the heart muscle or brain (encephalitis ). Without treatment, this type of typhus can be fatal.

Brill-Zinsser disease is quite mild, resulting in about a week-long fever, and a light rash similar to that of the original illness.

Endemic typhus causes about 12 days of high fever, with chills and headache. A light rash may occur.

Scrub typhus causes a wide variety of effects. The main symptoms include fever, headache, muscle aches and pains, cough, abdominal pain, nausea and vomiting, and diarrhea. Some patients experience only these symptoms. Some patients develop a rash, which can be flat or bumpy. The individual spots eventually develop crusty black scabs. Other patients go on to develop a more serious disease, in which encephalitis, pneumonia, and swelling of the liver and spleen (hepatosplenomegaly) occur.

Diagnosis

A number of tests exist that can determine the reactions of a patient's antibodies (immune cells in the blood) to the presence of certain viral and bacterial markers. When the antibodies react in a particular way, it suggests the presence of a rickettsial infection. Many tests require a fair amount of time for processing, so practitioners will frequently begin treatment without completing tests, simply on the basis of a patient's symptoms.

Treatment

The antibiotics tetracycline or chloramphenicol are used for treatment of each of the forms of typhus.

Prognosis

The prognosis depends on what types of complications an individual patient experiences. While children usually recover well from epidemic typhus, older adults may have as much as a 60% death rate without treatment. Brill-Zinsser, on the other hand, carries no threat of death. People usually recover uneventfully from endemic typhus, although the elderly, those with other medical problems, or people mistakenly treated with sulfa drugs may have a 1% death rate from the illness. Scrub typhus responds well to appropriate treatment, but untreated patients have a death rate of about 7%.

The relatively high death rate from untreated typhus is one reason why some researchers are concerned that its causative organisms might be used in the future as agents of bioterrorism.

Prevention

Prevention for each of these forms of typhus includes avoidance of the insects that carry the causative bacteria. Other preventive measures include good hygiene and the use of insect repellents.

KEY TERMS

Antibody Specialized cells of the immune system, which can recognize organisms that invade the body (such as bacteria, viruses, and fungi). The antibodies are then able to set off a complex chain of events designed to kill these foreign invaders.

Bioterrorism The use of disease microorganisms to intimidate or terrorize a civilian population.

Endemic Occurring naturally and consistently in a particular area.

Epidemic A large cluster of cases all occurring at about the same time within a specific community or region.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Epidemic Tyhpus." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Cunha, B. A. "The Cause of the Plague of Athens: Plague, Typhoid, Typhus, Smallpox, or Measles?" Infectious Diseases Clinics of North America 18 (March 2004): 29-43.

Ge, H., Y. Y. Chuang, S. Zhao, et al. "Comparative Genomics of Rickettsia prowazekii Madrid E and Breinl Strains." Journal of Bacteriology 186 (January 2004): 556-565.

Raoult, D., T. Woodward, and J. S. Dumler. "The History of Epidemic Typhus." Infectious Diseases Clinics of North America 18 (March 2004): 127-140.

ORGANIZATIONS

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

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"Typhus." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. 25 Jul. 2017 <http://www.encyclopedia.com>.

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Typhus

Typhus

Typhus is a disease caused by a group of bacteria called Rickettsia . Three forms of typhus are recognized: epidemic typhus, a serious disease that is fatal if not treated promptly; rat-flea or endemic typhus, a milder form of the disease; and scrub typhus, another fatal form. The Rickettsia species of bacteria that cause all three forms of typhus are transmitted by insects. The bacteria that cause epidemic typhus, for instance, are transmitted by the human body louse; the bacteria that cause endemic typhus are transmitted by the Oriental rat flea; and bacteria causing scrub typhus are transmitted by chiggers.

Typhus takes its name from the Greek word typhos meaning smoke, a description of the mental state of infected persons. Typhus is marked by a severe stupor and delirium, as well as headache, chills, and fever. A rash appears within four to seven days after the onset of the disease. The rash starts on the trunk and spreads to the extremities. In milder forms of typhus, such as endemic typhus, the disease symptoms are not severe. In epidemic and scrub typhus, however, the symptoms are extreme, and death can result from complications such as stroke, renal failure, and circulatory disturbances. Fatality can be avoided in these forms of typhus with the prompt administration of antibiotics .

Epidemic typhus is a disease that has played an important role in history. Because typhus is transmitted by the human body louse, epidemics of this disease break out when humans are in close contact with each other under conditions in which the same clothing is worn for long periods of time. Cold climates also favor typhus epidemics, as people will be more likely to wear heavy clothing in colder conditions. Typhus seems to be a disease of war, poverty, and famine. In fact, according to one researcher, Napoleon's retreat from Moscow in the early nineteenth century was beset by typhus. During World War I, more than three million Russians died of typhus, and during the Vietnam war, sporadic epidemics killed American soldiers.

Epidemic typhus is caused by Rickettsia prowazekii. Humans play a role in the life cycle of the bacteria. Lice become infected with the bacteria by biting an infected human; these infected lice then bite other humans. A distinguishing feature of typhus disease transmission is that the louse bite itself does not transmit the bacteria. The feces of the lice are infected with bacteria; when a person scratches a louse bite, the lice feces that have been deposited on the skin are introduced into the bloodstream.

If not treated promptly, typhus is fatal. Interestingly, a person who has had epidemic typhus can experience a relapse of the disease years after they have been cured of their infection. Called Brill-Zinsser disease, after the researchers who discovered it, the relapse is usually a milder form of typhus, which is treated with antibiotics. However, a person with Brill-Zinsser disease can infect lice, which can in turn infect other humans. Controlling Brill-Zinsser relapses is important in stopping epidemics of typhus before they start, especially in areas where lice infestation is prominent.

Endemic typhus is caused by R. typhi. These bacteria are transmitted by the Oriental rat flea, an insect that lives on small rodents. Endemic typhus (sometimes called murine typhus or rat-flea typhus) is found worldwide. The symptoms of endemic typhus are mild compared to those of epidemic typhus. In fact, many people do not seek treatment for their symptoms, as the rash that accompanies the disease may be short-lived. Deaths from endemic typhus have been documented, however; these deaths usually occur in the elderly and in people who are already sick with other diseases.

Scrub typhus is caused by R. tsutsugamushi, which is transmitted by chiggers. The term "scrub typhus" comes from the observation that the disease is found in habitats with scrub vegetation, but the name is somewhat of a misnomer. Scrub typhus is found in beach areas, savannas, tropical rains forests, deserts, or anywhere chiggers live. Scientists studying scrub typhus label a habitat that contains all the elements that might prompt an outbreak of the disease a "scrub typhus island." A scrub typhus island contains chiggers, rats, vegetation that will sustain the chiggers, and, of course, a reservoir of R. tsutsugamushi. Scrub typhus islands are common in the geographic area that includes Australia, Japan, Korea, India, and Vietnam.

The rash that occurs in scrub typhus sometimes includes a lesion called an eschar. An eschar is a sore that develops around the chigger bite. Scrub typhus symptoms of fever, rash, and chills may evolve into stupor, pneumonia , and circulatory failure if antibiotic treatment is not administered. Scrub typhus, like epidemic typhus, is fatal if not treated.

Prevention of typhus outbreaks takes a two-pronged approach. Eliminating the carriers and reservoirs of Rickettsia is an important step in prevention. Spraying with insecticides, rodent control measures, and treating soil with insect-repellent chemicals have all been used successfully to prevent typhus outbreaks. In scrub typhus islands, cutting down vegetation has been shown to lessen the incidence of scrub typhus. The second preventative prong is protecting the body from insect bites. Wearing heavy clothing when venturing into potentially insect-laden areas is one way to protect against insect bites; applying insect repellent to the skin is another. Proper personal hygiene , such as frequent bathing and changing of clothes, will eliminate human body lice and thus prevent epidemic typhus. A typhus vaccine is also available; however, this vaccine only lessens the severity and shortens the course of the disease, and does not protect against infection.

See also Bacteria and bacterial infection; Bioterrorism, protective measures; Infection control; Zoonoses

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typhus

typhus, any of a group of infectious diseases caused by microorganisms classified between bacteria and viruses, known as rickettsias. Typhus diseases are characterized by high fever and an early onset of rash and headache. They respond to antibiotic treatment with tetracycline and chloramphenicol and can be prevented by vaccination. Epidemic typhus, the most serious in the group, is caused by Rickettsia prowazeki, which is transmitted in the feces of body lice. It occurs in crowded, unsanitary conditions and has historically been a major killer in wartime. It occurs more commonly in cooler climates and seasons. Brill's disease, also called recrudescent typhus, is believed to be a milder recurrence of epidemic typhus. Endemic murine typhus is primarily a disease of rodents and is spread to humans by rat fleas. The symptoms are milder than those of epidemic typhus. Scrub typhus (Tsutsugamushi fever) is carried to humans by infected mites. It occurs primarily in East Asia and the Southeast Pacific islands.

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"typhus." The Columbia Encyclopedia, 6th ed.. . Encyclopedia.com. 25 Jul. 2017 <http://www.encyclopedia.com>.

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Typhus

Typhus

War, Famine, and Typhus

What Is Typhus?

Who Gets Typhus?

What Happens When People Have Typhus?

Resource

Typhus (TI-fus) is a group of infections caused by bacteria called rickettsiae that are spread by parasites such as lice that live on people or on other warm-blooded animals such as rats and mice.

KEYWORDS

for searching the Internet and other reference sources

Endemic typhus

Lice

Murine typhus

Scrub typhus

Rickettsial diseases

Typhus Epidemics

It is likely that typhus existed in ancient history, although the first clear historical description of typhus comes from the eleventh century, when an outbreak took place in a monastery in Sicily. Typhus reached epidemic proportions in 1489, during a siege in Granada. Typhus then spread throughout Europe.

Typhus also was present in the Americas, although there is some controversy as to whether Spanish explorers brought the disease in the sixteenth century, or whether the disease already was present in Aztec and other pre-Columbian societies.

In the early nineteenth century, typhus increased dramatically in Europe. In the twentieth century, typhus spread through Europe, North Africa, and the Pacific Islands, killing thousands of prisoners in German concentration camps.

War, Famine, and Typhus

Throughout history, war and famine have brought outbreaks of typhus, a group of infections spread by parasites that live on people or animals such as rats and mice. During World War II, typhus spread through Europe, North Africa, and the Pacific Islands, and it killed thousands of prisoners in German concentration camps. Epidemic typhus still can be a serious threat in parts of the world where a breakdown in society or a natural calamity such as an earthquake leads to unhealthy living conditions.

What Is Typhus?

Typhus is a group of infections caused by rickettsiae, a group of unusual bacteria. Rickettsiae are like other bacteria in that they can be killed by antibiotics. They are also like viruses, however, in that they must invade living cells in order to grow. There are three main types of typhus: epidemic, murine, and scrub.

  • Epidemic typhus, caused by Rickettsia prowazekii, is a severe form of the disease spread by human body lice. In the United States, this type of typhus also occasionally is spread by lice and fleas on flying squirrels. Sometimes the symptoms of people with typhus become active again years after the original attack; this is called Brill-Zinsser disease. Brill-Zinsser disease is milder than epidemic typhus.
  • Murine typhus, caused by Rickettsia typhi, is a milder form of the disease and is spread by fleas on rats, mice, and other rodents.
  • Scrub typhus, caused by Rickettsia tsutsugamushi, is a form of the disease found in the Asian-Pacific area bounded by Japan, Australia, and the Indian subcontinent. It is spread by mites on rats, field mice, and other rodents.

Who Gets Typhus?

Both epidemic and murine typhus are found around the world. However, epidemic typhus is most common in situations where poor hygiene and crowded living conditions exist. Epidemic typhus is rare in the United States. Murine typhus is most common in rat-infested areas. It is the only type of typhus that occurs regularly in the United States, but fewer than 100 cases a year are reported, mainly in Texas and California.

What Happens When People Have Typhus?

Symptoms

The symptoms of typhus include fever, headache, chills, and general aches that are followed by a rash. The rash spreads to most of the body but usually does not affect the face, palms of the hands, or soles of the feet. In murine typhus, the symptoms are similar but milder. In epidemic and scrub typhus, the fever may rise as high as 104 to 105 degrees Fahrenheit and stay high for about two weeks. The headache is intense.

In severe cases of typhus, blood pressure may drop dangerously. Severe illness also may lead to confusion, seizures, coma, or even death. This accounts for the diseases name, which comes from the Greek word typhös, meaning smoke, a cloud, or a stupor arising from a fever.

Diagnosis and Treatment

Blood tests are used to show if people are infected with typhus rickettsiae. People with typhus who are treated with antibiotics generally recover. If treatment is begun early, they usually get better quickly. If treatment is delayed, however, the improvement usually is slower, and the fever lasts longer. If left untreated, typhus can damage organs, lead to coma, and even to death.

Prevention

Prevention of typhus is based on avoiding the unsanitary conditions in which it spreads. It is always wise to steer clear of animals such as rats and mice that may carry disease. Travelers to areas where typhus is common should be especially cautious. To prevent the spread of typhus, body lice must be destroyed by removing them from people with the disease and by boiling or steaming their clothes.

See also

Bacterial Infections

Lice

Rocky Mountain Spotted Fever

Resource

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road N.E., Atlanta, GA 30333. The website for this government agency has information about typhus and other rickettsial infections. Telephone 800-311-3435 http://www.cdc.gov

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typhus

typhus (spotted fever) (ty-fŭs) n. any one of a group of infections caused by rickettsiae and characterized by severe headache, a widespread rash, prolonged high fever, and delirium. They all respond to treatment with chloramphenicol or tetracyclines. The rickettsiae may be transmitted by lice (epidemic, classical, or louse-borne t.); rat fleas (endemic, murine, or flea-borne t.); ticks (see Rocky Mountain spotted fever); or mites (see rickettsial pox, scrub typhus).

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typhus

ty·phus / ˈtīfəs/ • n. an infectious disease caused by rickettsiae, characterized by a purple rash, headaches, fever, and usually delirium, and historically a cause of high mortality during wars and famines. There are several forms, transmitted by vectors such as lice, ticks, mites, and rat fleas. Also called spotted fever. DERIVATIVES: ty·phous / -fəs/ adj.

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typhus

typhus Any of a group of infectious diseases caused by rickettsiae (small bacteria) and spread by parasites of the human body such as lice, fleas, ticks and mites. Epidemic typhus, the result of infection by Rickettsia prowazekii, is the most serious manifestation. Associated with dirty, overcrowded conditions, it is mainly seen during times of war or famine.

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typhus

typhus infectious fever. XVIII. — modL. tȳphus — Gr. tûphos smoke, vapour, stupor, f. túphein smoke.
Hence typhoid resembling typhus; applied spec. to a fever marked by intestinal inflammation and formerly supposed to be a variety of typhus. XVIII. f. TYPHUS + -OID.

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typhus

typhushorrendous, stupendous, tremendous •Barbados • Indus • solidus • Lepidus •Midas, nidus •Aldous • Judas • Enceladus • exodus •hazardous • Dreyfus • Josephus •Sisyphus • typhus • Dollfuss •amorphous, anthropomorphous, polymorphous •rufous, Rufus •Angus • Argus •Las Vegas, magus, Tagus •negus •anilingus, cunnilingus, dingus, Mingus •bogus •fungous, fungus, humongous •anthropophagous, oesophagus (US esophagus), sarcophagus •analogous •homologous, tautologous •Areopagus • asparagus •Burgas, Fergus, Lycurgus •Carajás • frabjous •advantageous, contagious, courageous, outrageous, rampageous •egregious •irreligious, litigious, prestigious, prodigious, religious, sacrilegious •umbrageous • gorgeous

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