Vaccines have been developed, but none are commercially available.[3][4][5] Prevention is achieved by reducing exposure to the organisms that spread the disease.[3][4][5] Treatment is with the antibioticdoxycycline.[2] Epidemic typhus generally occurs inoutbreaks when poor sanitary conditions and crowding are present.[6] While once common, it is now rare.[3] Scrub typhus occurs inSoutheast Asia,Japan, and northernAustralia.[4] Murine typhus occurs intropical andsubtropical areas of the world.[5]
Typhus has been described since at least 1528.[7] The name comes from theGreektûphos (τῦφος), meaning 'hazy' or 'smoky' and commonly used as a word for delusion, describing the state of mind of those infected.[7] Whiletyphoid means 'typhus-like', typhus andtyphoid fever are distinct diseases caused by different types of bacteria, the latter by specific strains ofSalmonella typhi.[8] However, in some languages such asGerman, the termtyphus does mean 'typhoid fever', and the here-described typhus is called by another name, such as the language's equivalent of 'lice fever'.
These signs and symptoms refer to epidemic typhus, as it is the most severe of the typhus group of diseases.[9]
Signs and symptoms begin with sudden onset of fever and otherflu-like symptoms about one to two weeks after being infected.[10] Five to nine days after the symptoms have started, a rash typically begins on the trunk and spreads to the extremities. This rash eventually spreads over most of the body, sparing the face, palms, and soles. Signs ofmeningoencephalitis begin with the rash and continue into the second or third weeks.[citation needed] Other signs of meningoencephalitis include sensitivity to light (photophobia), altered mental status (delirium), or coma. Untreated cases are often fatal.[11]
Signs ofscrub typhus usually start within 1 to 2 weeks after being infected. These symptoms include fever, headaches, chills, swollen lymph nodes, nausea/vomiting, and a rash at the site of infection called aneschar. More severe symptoms may damage the lungs, brain, kidney, meninges, and heart.[12]
When the term "typhus" is used without qualification, this is usually the condition described. Historical references to "typhus" are now generally considered to be this condition.[citation needed]
The main method of diagnosing typhus of all types is laboratory testing. It is most commonly done with an indirect immunofluorescence antibody IFA test for all types of typhus. This tests a sample for the antibodies associated with typhus. It can also be done with either immunohistochemistry (IHC) or polymerase chain reaction (PCR) tests excluding scrub typhus. Scrub typhus is not tested with IHC or PCR but is instead tested with the IFA test as well as indirect immunuoperoxidase (IIP) assays.[14]
Scrub typhus is caused by mites, so avoiding the outdoors when scrub is common in the area is advised. Making sure clothing is treated withpermethrin to prevent mite bites, and use of insect repellent is recommended to keep mites away. It is also advised to dress children and babies in clothing that covers their limbs, and to put a mosquito cover over babies in stroller.[16]
Epidemic typhus is caused by body lice and thrives in areas with overcrowding, so if possible highly populated areas should be avoided. Also, make sure to regularly clean yourself and your clothing to help kill lice. This also goes for things like bedding and towels. Make sure to not share any fabric items with anyone who has lice or typhus. Lastly, treating clothing withpermethrin can help in killing lice.[3]
Murine typhus is caused by flea bites which can be avoided by making sure pets do not have fleas. If they do, they should be treated, and avoided. One should also avoid contact with wild animals, use insect repellent to keep fleas away, and wear gloves when dealing with sick or dead animals. Taking steps to ensure rodents or other wildlife do not get into one's home is also recommended.[17]
TheAmerican Public Health Association recommends treatment based upon clinical findings and before culturing confirms the diagnosis.[18] Without treatment, death may occur in 10% to 60% of people with epidemic typhus, with people over age 50 having the highest risk of death.[19] In the antibiotic era, death is uncommon ifdoxycycline is given. In one study of 60 people hospitalized with epidemic typhus, no one died when given doxycycline orchloramphenicol.[20]
According to theWorld Health Organization, in 2010 the death rate from typhus was about one of every 5,000,000 people per year.[21]
Only a few areas of epidemic typhus exist today. Since the late 20th century, cases have been reported in Burundi, Rwanda, Ethiopia, Algeria, and a few areas in South and Central America.[22][23][24][25]
Except for two cases, all instances of epidemic typhus in the United States have occurred east of theMississippi River. An examination of a cluster of cases in Pennsylvania concluded the source of the infection wasflying squirrels.[26]Sylvatic cycle (diseases transmitted from wild animals) epidemic typhus remains uncommon in the US. TheCenters for Disease Control and Prevention have documented only 47 cases from 1976 to 2010.[27] An outbreak offlea-borne murine typhus was identified in downtownLos Angeles, California, in October 2018.[28]
The first reliable description of typhus appears in 1489 AD during the Spanish siege ofBaza against theMoors during theWar of Granada (1482–1492). These accounts include descriptions of fever; red spots over arms, back, and chest; attention deficit, progressing to delirium; andgangrenous sores and the associated smell of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action, but an additional 17,000 died of typhus.[29]
In historical times,[when?] "jail fever" or "gaol fever" was common in English prisons, and is believed by modern authorities to have been typhus. It often occurred when prisoners were crowded together into dark, filthy rooms where lice spread easily. Thus, "imprisonment until the next term of court" was often equivalent to a death sentence. Prisoners brought before the court sometimes infected members of the court.[30] TheBlack Assize of Exeter 1586 was another notable outbreak. During the Lent assizes court held atTaunton in 1730, gaol fever caused the death of theLord Chief Baron, as well as theHigh Sheriff, the sergeant, and hundreds of others. During a time when persons were executed for capital offences, 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.[30] InLondon, gaol fever frequently broke out among the ill-kept prisoners ofNewgate Prison and then moved into the general city population. In May 1750, theLord Mayor of London, SirSamuel Pennant, and many court personnel were fatally infected in the courtroom of theOld Bailey, which adjoined Newgate Prison.[31]
Epidemics occurred routinely throughout Europe from the 16th to the 19th centuries, including during theEnglish Civil War, theThirty Years' War, and theNapoleonic Wars.[32] Pestilence of several kinds raged among combatants and civilians inGermany and surrounding lands from 1618 to 1648. According to Joseph Patrick Byrne, "By war's end, typhus may have killed more than 10 percent of the total German population, and disease in general accounted for 90 percent of Europe's casualties."[33]
A major epidemic occurred inIreland between 1816 and 1819, during the famine caused by a worldwide reduction in temperature known as theYear Without a Summer. An estimated 100,000 people perished. Typhus appeared again in the late 1830s, and yet another major typhus epidemic occurred during theGreat Irish Famine between 1846 and 1849. The typhus outbreak along withtyphoid fever is said to be responsible for 400,000 deaths.[35] 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.[36]
InCanada alone, thetyphus epidemic of 1847 killed more than 20,000 people from 1847 to 1848, mainly Irish immigrants infever sheds and other forms of quarantine, who had contracted the disease aboard the crowdedcoffin ships in fleeing theGreat Irish Famine. Officials neither knew how to provide sufficient sanitation under conditions of the time nor understood how the disease spread.[38]
Typhus wasendemic inPoland and several neighboring countries prior toWorld War I (1914–1918), but becameepidemic during the war.[39][40][41] Delousing stations were established for troops on theWestern Front duringWorld War I, including the use ofshower trains,[42] but typhus ravaged the armies of theEastern Front, where over 150,000 died inSerbia alone.[43] Fatalities were generally between 10% and 40% of those infected and the disease was a major cause of death for those nursing the sick.[citation needed]
In 1922, the typhus epidemic reached its peak in Soviet territory, with some 20 to 30 million cases inRussia.[44] Although typhus had ravagedPoland with some 4 million cases reported, efforts to stem the spread of disease in that country had largely succeeded by 1921 through the efforts of public health pioneers such asHélène Sparrow andRudolf Weigl.[45] In Russia during thecivil war between theWhite andRed Armies, epidemic typhus killed 2–3 million people, many of whom were civilians.[41][44][46][47] In 1937 and 1938, there was a typhus epidemic inChile.[48] On 6 March 1939, Prime Minister of FranceÉdouard Daladier stated to the French parliament, he would return 300,000 of the Spanish refugees fleeing from the 1938Spanish Civil War; reasons included the typhus spread in the French refugee camps, as well as France's sovereign recognition ofFrancisco Franco.[49]
DuringWorld War II, many German POWs after theloss at Stalingrad died of typhus. Typhus epidemics killed those confined to POW camps, ghettos, andNazi concentration camps who were held in unhygienic conditions. Pictures of mass graves including people who died from typhus can be seen in footage shot atBergen-Belsen concentration camp.[50] Among thousands of prisoners in concentration camps such asTheresienstadt and Bergen-Belsen who died of typhus[50] wereAnne Frank, age 15, and her sisterMargot, age 19, in the latter camp.
The first typhus vaccine was developed by thePolishzoologistRudolf Weigl in the interwar period; the vaccine did not prevent the disease but reduced its mortality.[51]
Charles Nicolle received the 1928Nobel Prize in Medicine for his identification of lice as the transmitter of epidemic typhus.
A US soldier is demonstratingDDT hand-spraying equipment. DDT was used to control the spread of typhus-carrying lice.
Women suffering from Typhus at Bergen-Belsen concentration camp, shortly after liberation. Typhus rapidly spread in the unhygenic, crowded conditions of concentration camps.
In 2018 a murine typhus outbreak spread throughLos Angeles County, primarily affecting homeless people.[52] In 2019, city attorney Elizabeth Greenwood revealed that she was infected with typhus from a flea bite at her office inLos Angeles City Hall.[53][54] Pasadena also experienced a sudden uptick in typhus with 22 cases in 2018 but, without being able to attribute this to one location, the Pasadena Public Health Department did not identify the cases as an "outbreak".[55] Over the past decade as well murine typhus cases have been rising with the highest number of cases being 171 in 2022.[56]
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^abSmith RD (January 1967). "Criminal Law—Arrest—The Right to Resist Unlawful Arrest".Natural Resources Journal.7 (1):119–28. (hereinafter Comment) (citingHoward J (1929).The State of the Prisons. J.M. Dent & Sons Ltd. pp. 6–7.) (Howard's observations are from 1773 to 1775). Copied fromState v. Valentine (May 1997) 132 Wn.2d 1, 935 P.2d 1294
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