|Synonyms||camp fever, jail fever, hospital fever, ship fever, famine fever, putrid fever, petechial fever, epidemic louse-borne typhus, louse-borne typhus|
|Rash caused by epidemic typhus|
|Specialty|| Infectious disease |
Epidemic typhus 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).
Typhus, also known as typhus fever, is a group of infectious diseases that include epidemic typhus, scrub typhus and murine typhus. Common symptoms include fever, headache, and a rash. Typically these begin one to two weeks after exposure.
Rickettsia prowazekii is a species of gram-negative, alphaproteobacteria, obligate intracellular parasitic, aerobic Bacillus bacteria that is the etiologic agent of epidemic typhus, transmitted in the feces of lice. In North America, the main reservoir for R. prowazekii is the flying squirrel. R. prowazekii is often surrounded by a protein microcapsular layer and slime layer; the natural life cycle of the bacterium generally involves a vertebrate and an invertebrate host, usually an arthropod, typically the human body louse. A form of R. prowazekii that exists in the feces of arthropods remains stably infective for months. R. prowazekii also appears to be the closest free-living relative of mitochondria, based on genome sequencing.
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).
A rash is a change of the human skin which affects its color, appearance, or texture.
Chills is a feeling of coldness occurring during a high fever, but sometimes is also a common symptom which occurs alone in specific people. It occurs during fever due to the release of cytokines and prostaglandins as part of the inflammatory response, which increases the set point for body temperature in the hypothalamus. The increased set point causes the body temperature to rise (pyrexia), but also makes the patient feel cold or chills until the new set point is reached. Shivering also occurs along with chills because the patient's body produces heat during muscle contraction in a physiological attempt to increase body temperature to the new set point. When it does not accompany a high fever, it is normally a light chill. Sometimes a chill of medium power and short duration may occur during a scare, especially in scares of fear, commonly interpreted like or confused by trembling.
Blood pressure (BP) is the pressure of circulating blood on the walls of blood vessels. Most of this pressure is due to work done by the heart by pumping blood through the circulatory system. Used without further specification, "blood pressure" usually refers to the pressure in large arteries of the systemic circulation. Blood pressure is usually expressed in terms of the systolic pressure over diastolic pressure and is measured in millimeters of mercury (mmHg), above the surrounding atmospheric pressure.
Brill-Zinsser disease, first described by Nathan Brill in 1913 at 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.
The City of New York, usually called either New York City (NYC) or simply New York (NY), is the most populous city in the United States and in the U.S. state of New York. With an estimated 2017 population of 8,622,698 distributed over a land area of about 302.6 square miles (784 km2), New York is also the most densely populated major city in the United States. Located at the southern tip of the state of New York, the city is the center of the New York metropolitan area, the largest metropolitan area in the world by urban landmass and one of the world's most populous megacities, with an estimated 20,320,876 people in its 2017 Metropolitan Statistical Area and 23,876,155 residents in its Combined Statistical Area. A global power city, New York City has been described as the cultural, financial, and media capital of the world, and exerts a significant impact upon commerce, entertainment, research, technology, education, politics, tourism, art, fashion, and sports. The city's fast pace has inspired the term New York minute. Home to the headquarters of the United Nations, New York is an important center for international diplomacy.
Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over. It usually starts on the chest, back, and face then spreads to the rest of the body. Other symptoms may include fever, tiredness, and headaches. Symptoms usually last five to seven days. Complications may occasionally include pneumonia, inflammation of the brain, and bacterial skin infections. The disease is often more severe in adults than in children. Symptoms begin 10 to 21 days after exposure to the virus.
Shingles, also known as zoster or herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area. Typically the rash occurs in a single, wide stripe either on the left or right side of the body or face. Two to four days before the rash occurs there may be tingling or local pain in the area. Otherwise there are typically few symptoms though some may have fever, headache, or feel tired. The rash usually heals within two to four weeks; however, some people develop ongoing nerve pain which can last for months or years, a condition called postherpetic neuralgia (PHN). In those with poor immune function the rash may occur widely. If the rash involves the eye, vision loss may occur.
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Feeding on a human who carries the bacterium 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.
Feces are the solid or semisolid remains of the food that could not be digested in the small intestine. Bacteria in the large intestine further break down the material. Feces contain a relatively small amount of metabolic waste products such as bacterially altered bilirubin, and the dead epithelial cells from the lining of the gut.
Incubation period is the time elapsed between exposure to a pathogenic organism, a chemical, or radiation, and when symptoms and signs are first apparent. In a typical infectious disease, incubation period signifies the period taken by the multiplying organism to reach a threshold necessary to produce symptoms in the host.
Epidemic typhus has historically occurred during times of war and deprivation. For example, typhus killed millions of prisoners in Nazi concentration camps during World War II. The deteriorating quality of hygiene in camps such as Auschwitz, Theresienstadt, and 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.
Nazi Germany is the common English name for Germany between 1933 and 1945, when Adolf Hitler and his Nazi Party (NSDAP) controlled the country through a dictatorship. Under Hitler's rule, Germany was transformed into a totalitarian state that controlled nearly all aspects of life via the Gleichschaltung legal process. The official name of the state was Deutsches Reich until 1943 and Großdeutsches Reich from 1943 to 1945. Nazi Germany is also known as the Third Reich, meaning "Third Realm" or "Third Empire", the first two being the Holy Roman Empire (800–1806) and the German Empire (1871–1918). The Nazi regime ended after the Allies defeated Germany in May 1945, ending World War II in Europe.
World War II, also known as the Second World War, was a global war that lasted from 1939 to 1945. The vast majority of the world's countries—including all the great powers—eventually formed two opposing military alliances: the Allies and the Axis. A state of total war emerged, directly involving more than 100 million people from over 30 countries. The major participants threw their entire economic, industrial, and scientific capabilities behind the war effort, blurring the distinction between civilian and military resources. World War II was the deadliest conflict in human history, marked by 50 to 85 million fatalities, most of whom were civilians in the Soviet Union and China. It included massacres, the genocide of the Holocaust, strategic bombing, premeditated death from starvation and disease, and the only use of nuclear weapons in war.
Bergen-Belsen[ˈbɛʁɡn̩.bɛlsn̩], or Belsen, was a Nazi concentration camp in what is today Lower Saxony in northern Germany, southwest of the town of Bergen near Celle. Originally established as a prisoner of war camp, in 1943, parts of it became a concentration camp. Initially this was an "exchange camp", where Jewish hostages were held with the intention of exchanging them for German prisoners of war held overseas. The camp was later expanded to accommodate Jews from other concentration camps.
Henrique da Rocha Lima in 1916 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 methodby 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.
Henrique da Rocha Lima was a Brazilian physician, pathologist and infectologist born in Rio de Janeiro. With his friend, Stanislaus von Prowazek, he described what would later be known as Rickettsia prowazekii, the pathogen of epidemic typhus. Rocha Lima named the organism after Prowazek and American bacteriologist Howard Taylor Ricketts (1871-1910).
Stanislaus Josef Mathias von Prowazek, Edler von Lanow, born Stanislav Provázek, was a Czech zoologist and parasitologist, who along with pathologist Henrique da Rocha Lima (1879-1956) discovered the pathogen of epidemic typhus.
Rudolf Stefan Jan Weigl was a Polish biologist and inventor of the first effective vaccine against epidemic typhus. He founded the Weigl Institute in Lviv, where he conducted vaccine research.
A safer mass-production-ready method using egg yolks was developed by Herald R. Cox in 1938.This vaccine was widely available and used extensively by 1943.
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IFA, ELISA or PCR positive after 10 days
The infection is treated with antibiotics. Intravenous fluids and oxygen may be needed to stabilize the patient. There is a significant disparity between the untreated mortality and treated mortality rates: 10-60% untreated versus close to 0% treated with antibiotics within 8 days of initial infection. Tetracycline, Chloramphenicol, and doxycyclineare commonly used. Infection can also be prevented by vaccination.
Some of the simplest methods of prevention and treatment focus on preventing infestation of body lice. Complete change of clothing, washing the infested clothing in hot water, and in some cases also treating recently used bedsheets all help to prevent typhus by removing potentially infected lice. Clothes also left unworn and unwashed for 7 days also cause both lice and their eggs to die, as they have no access to their human host.Another form of lice prevention requires dusting infested clothing with a powder consisting of 10% DDT, 1% malathion, or 1% permethrin, which kill lice and their eggs.
The first description of typhus was probably given in 1083 at La Cava abbey near Salerno, Italy.In 1546, Girolamo Fracastoro, a Florentine physician, described typhus in his famous treatise on viruses and contagion, De Contagione et Contagiosis Morbis.
Typhus was a devastating disease for humans and was responsible for hundreds of thousands of deaths during WWII.
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 a strong candidate for the cause of this disease outbreak, supported by both medical and scholarly opinions.
Typhus also arrived in Europe with soldiers who had been fighting on Cyprus. The first reliable description of the disease appears during the siege of the Emirate of Granada by the Catholic Monarchs in 1489 during the Granada War. 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 Catholics lost 3,000 men to enemy action while 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 Black Assize of Oxford 1577, over 300 died from epidemic typhus, including Speaker Robert Bell, Lord Chief Baron of the Exchequer. The outbreak that followed, between 1577 and 1579, killed about 10% of the English population. During the Lent assize held at Taunton (1730) typhus caused the death of the Lord Chief Baron of the Exchequer, as well as the High Sheriff of Somerset, 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.In London, typhus frequently broke out among the ill-kept prisoners of Newgate Gaol and then moved into the general city population.
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 of his 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, while 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 1847 North American typhus epidemic killed more than 20,000 people, mainly Irish immigrants in fever sheds and other forms of quarantine, who had contracted the disease aboard coffin ships.
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, D.C. between 1865 and 1873. Typhus fever was also a significant killer during the American Civil War, although typhoid fever was the more prevalent cause of US Civil War "camp fever." Typhoid is a completely different disease from typhus.
Physician, anthropologist, historian Rudolph Carl Virchow’s attempt to control an outbreak of typhus in Upper Silesia and his subsequent 190 page report included the observation that the solution to the outbreak did not lie in individual treatment or small changes in housing, food or clothing provided, but rather in widespread structural changes that directly addressed the issue of poverty. Virchow’s experience in Upper Silesia led to the observation that “Medicine is a social science”. His report led to changes in German public health policy.
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 and 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 Russian Civil War between the White and Red, typhus killed three million, largely civilians.
During World War II, typhus struck the German Army during Operation Barbarossa, the invasion of Russia, in 1941.In 1942 and 1943 typhus hit French North Africa, Egypt and Iran particularly hard. Typhus epidemics killed inmates in the Nazi concentration camps; infamous pictures of typhus victims' mass graves can be seen in footage shot at Bergen-Belsen concentration camp. Thousands of prisoners held in appalling conditions in Nazi concentration camps such as Auschwitz, Theresienstadt, and Bergen-Belsen also died of typhus during World War II, 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.
In one of its first major outbreaks since World War II, epidemic typhus reemerged in 1995 in a jail in N'Gozi, Burundi. This outbreak followed the outbreak of the Burundian Civil War in 1993 that caused the displacement of 760,000 people. Refugee camps were crowded and unsanitary, often far from towns and medical services.
A 2005 study found discovered seroprevalence of R. prowazekii antibodies in homeless populations in two shelters in Marseille, France, noting the “hallmarks of epidemic typhus and relapsing fever”.
Typhus was one of more than a dozen agents that the United States researched as potential biological weapons before President Richard Nixon suspended all non-defensive aspects of the U.S. biological weapons program in 1969.
The CDC lists the following areas as active foci of human epidemic typhus: Andean regions of South America, some parts of Africa; on the other hand, the CDC only recognizes an active enzootic cycle in the United States involving flying squirrels (CDC). Though epidemic typhus is commonly thought to be restricted to areas of the developing world, serological examination of homeless persons in Houston found evidence for exposure to the bacterial pathogens that cause epidemic typhus and murine typhus. A study involving 930 homeless people in Marseilles, France found high rates of seroprevalence to R. prowazekii and a high prevalence of louse-borne infections in the homeless.
Typhus has been increasingly discovered in homeless populations in developed nations. Typhus among homeless populations is especially prevalent as these populations tend to migrate across states and countries, spreading the risk of infection with their movement. The same risk applies to refugees, who travel across country lines, often living in close proximity and unable to maintain necessary hygienic standards to avoid being at risk for catching lice possibly infected with typhus.
Because the typhus-infected lice live in clothing, the prevalence of typhus is also affected by weather, humidity, poverty and lack of hygiene. Lice, and therefore typhus, are more prevalent during colder months, especially winter and early spring. In these seasons, people tend to wear multiple layers of clothing, giving lice more places to go unnoticed by their hosts. This is particularly a problem for poverty-stricken populations as they often do not have multiple sets of clothing, preventing them from practicing good hygiene habits that could prevent louse infestation.
Due to fear of an outbreak of epidemic typhus, the US Government put a typhus quarantine in place in 1917 across the entirety of the US-Mexican border. Sanitation plants were constructed that required immigrants to be thoroughly inspected and bathed before crossing the border. Those who routinely crossed back and forth across the border for work were required to go through the sanitation process weekly, updating their quarantine card with the date of the next week’s sanitation. These sanitation border stations remained active over the next two decades, regardless of the disappearance of the typhus threat. This fear of typhus and resulting quarantine and sanitation protocols dramatically hardened the border between the US and Mexico, fostering scientific and popular prejudices against Mexicans. This ultimately intensified racial tensions and fueled efforts to ban immigrants to the US from the Southern Hemisphere because the immigrants were associated with the disease.
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A pandemic is an epidemic of disease that has spread across a large region; for instance multiple continents, or even worldwide. This may include communicable and noncommunicable diseases.
Typhoid fever, also known simply as typhoid, is a bacterial infection due to Salmonella typhi that causes symptoms. Symptoms may vary from mild to severe and usually begin six to thirty days after exposure. Often there is a gradual onset of a high fever over several days; weakness, abdominal pain, constipation, headaches, and mild vomiting also commonly occur. Some people develop a skin rash with rose colored spots. In severe cases there may be confusion. Without treatment, symptoms may last weeks or months. Diarrhea is uncommon. Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. Typhoid fever is a type of enteric fever, along with paratyphoid fever.
Pediculosis is an infestation of lice. The condition can occur in almost any species of warm-blooded animal, including humans. Although pediculosis in humans may properly refer to lice infestation of any part of the body, the term is sometimes used loosely to refer to pediculosis capitis, the infestation of the human head with the specific head louse.
Trench fever is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Macedonia, Mesopotamia, Russia and Egypt in World War I. Three noted sufferers during WWI were the authors J. R. R. Tolkien, A. A. Milne, and C. S. Lewis. From 1915 to 1918 between one-fifth and one-third of all British troops reported ill had trench fever while about one-fifth of ill German and Austrian troops had the disease. The disease persists among the homeless. Outbreaks have been documented, for example, in Seattle and Baltimore in the United States among injection drug users and in Marseille, France, and Burundi.
Brill–Zinser disease is a delayed relapse of epidemic typhus, caused by Rickettsia prowazekii. After a patient contracts epidemic typhus from the fecal matter of an infected louse, the rickettsia can remain latent and reactivate months or years later, with symptoms similar to or even identical to the original attack of typhus, including a maculopapular rash. This reactivation event can then be transmitted to other individuals through fecal matter of the louse vector, and form the focus for a new epidemic of typhus.
Charles Jules Henry Nicolle was a French bacteriologist who received the Nobel Prize in Medicine for his identification of lice as the transmitter of epidemic typhus.
Murine typhus is a form of typhus transmitted by fleas, usually on rats. Murine typhus is an under-recognized entity, as it is often confused with viral illnesses. Most people who are infected do not realize that they have been bitten by fleas.
Relapsing fever is a vector-borne disease caused by infection with certain bacteria in the genus Borrelia, which are transmitted through the bites of lice or soft-bodied ticks.
The body louse is a louse that infests humans. The condition of being infested with head lice, body lice, or pubic lice is known as pediculosis. Body lice are vectors for the transmission of the human diseases epidemic typhus, trench fever, and relapsing fever. The body louse genome sequence analysis was published in 2010.
Bartonella quintana, originally known as Rochalimaea quintana, and "Rickettsia quintana", is a micro-organism transmitted by the human body louse. This microorganism is the causative agent of the well known trench fever. This bacterium caused outbreaks of trench fever affecting 1 million soldiers in Europe during World War I.
Rickettsia conorii is a Gram-negative, obligate intracellular bacterium of the genus Rickettsia that causes human disease called Boutonneuse fever, Mediterranean spotted fever, Israeli tick typhus, Astrakhan spotted fever, Kenya tick typhus, Indian tick typhus, or other names that designate the locality of occurrence while having distinct clinical features. It is a member of the spotted fever group and the most geographically dispersed species in the group, recognized in most of the regions bordering on the Mediterranean Sea and Black Sea, Israel, Kenya, and other parts of North, Central, and South Africa, and India. The prevailing vector is the brown dog tick, Rhipicephalus sanguineus. The bacterium was isolated by Emile Brumpt in 1932 and named after A. Conor who, in collaboration with A. Bruch, provided the first description of boutonneuse fever in Tunisia in 1910.
Pediculosis corporis is a cutaneous condition caused by body lice that lay their eggs in the seams of clothing.
Flying squirrel typhus is a condition characterized by a rash of early macules, and, later, maculopapules.
Rickettsia felis is a species of bacterium, the pathogen that causes cat-flea typhus in humans. In cats the disease is known as flea-borne spotted fever. Rickettsia felis also is regarded as the causative organism of many cases of illnesses generally classed as fevers of unknown origin in humans in Africa.
A feeder of lice was a job in interwar and Nazi-occupied Poland, in the city of Lwów at the Institute for Study of Typhus and Virology of Rudolf Weigl in Lwów. It involved serving as a source of blood for lice, a typhus vector, which could then be used to develop vaccines against the disease.
Diseases and epidemics of the 19th century reached epidemic proportions in the case of one emerging infectious disease: cholera. Other important diseases at that time in Europe and other regions included smallpox, typhus and yellow fewer.