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Other namesTyphus fever
Epidemic typhus Burundi.jpg
Rash caused by epidemic typhus
Specialty Infectious disease
SymptomsFever, headache, rash [1]
Usual onset1–2 weeks after exposure [2]
CausesBacterial infection spread by parasites [1]
Treatment Doxycycline [2]
FrequencyRare [3]

Typhus, also known as typhus fever, is a group of infectious diseases that include epidemic typhus, scrub typhus and murine typhus. [1] Common symptoms include fever, headache, and a rash. [1] Typically these begin one to two weeks after exposure. [2]

Epidemic typhus Human 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.

Scrub typhus form of typhus caused by the intracellular parasite Orientia tsutsugamushi

Scrub typhus or bush typhus is a form of typhus caused by the intracellular parasite Orientia tsutsugamushi, a Gram-negative α-proteobacterium of family Rickettsiaceae first isolated and identified in 1930 in Japan.

Murine typhus typhus transmitted by fleas (Xenopsylla cheopis), usually on rats

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.


The diseases are caused by specific types of bacterial infection. [1] Epidemic typhus is due to Rickettsia prowazekii spread by body lice, scrub typhus is due to Orientia tsutsugamushi spread by chiggers, and murine typhus is due to Rickettsia typhi spread by fleas. [1]

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.

<i>Orientia tsutsugamushi</i> species of bacterium

Orientia tsutsugamushi is a mite-borne bacterium belonging to the family Rickettsiaceae and is responsible for a disease called scrub typhus in humans. It is a natural and an obligate intracellular parasite of mites belonging to the family Trombiculidae. With a genome of only 2.4–2.7 Mb, it has the most repeated DNA sequences among bacterial genomes sequenced so far. The disease, scrub typhus, occurs when infected mite larvae accidentally bite humans. Primarily indicated by undifferentiated febrile illnesses, the infection can be complicated and often fatal.

Rickettsia typhi is a species of infectious bacterium of the genus Rickettsia; it is the causative agent of Murine typhus.

There is currently no commercially available vaccine. [3] [4] [5] Prevention is by reducing exposure to the organisms that spread the disease. [3] [4] [5] Treatment is with the antibiotic doxycycline. [2] Epidemic typhus generally occurs in outbreaks when poor sanitary conditions and crowding are present. [6] While once common, it is now rare. [3] Scrub typhus occurs in Southeast Asia, Japan, and northern Australia. [4] Murine typhus occurs in tropical and subtropical areas of the world. [5]

Vaccine biological preparatory medicine that improves immunity to a particular disease

A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future. Vaccines can be prophylactic, or therapeutic.

Doxycycline chemical compound

Doxycycline is an antibiotic that is used in the treatment of infections caused by bacteria and certain other parasites. It is used to treat bacterial pneumonia, acne, chlamydia infections, early Lyme disease, cholera, and syphilis. It is also used to prevent malaria and in combination with quinine, to treat malaria. Doxycycline can be used either by mouth or by injection into a vein.

Typhus has been described since at least 1528 AD. [7] The name comes from the Greek tûphos (τύφος) meaning hazy, describing the state of mind of those infected. [7] While "typhoid" means "typhus-like", typhus and typhoid fever are distinct diseases caused by different types of bacteria. [8]

Ancient Greek Version of the Greek language used from roughly the 9th century BCE to the 6th century CE

The Ancient Greek language includes the forms of Greek used in Ancient Greece and the ancient world from around the 9th century BCE to the 6th century CE. It is often roughly divided into the Archaic period, Classical period, and Hellenistic period. It is antedated in the second millennium BCE by Mycenaean Greek and succeeded by medieval Greek.

Typhoid fever A bacterial infectious disorder contracted by consumption of food or drink contaminated with Salmonella typhi. This disorder is common in developing countries and can be treated with antibiotics.

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. This is commonly accompanied by weakness, abdominal pain, constipation, headaches, and mild vomiting. Some people develop a skin rash with rose colored spots. In severe cases people may experience 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.

Signs and symptoms

The following signs and symptoms refer to epidemic typhus as it is the most important of the typhus group of diseases. [9]

Signs and symptoms begin with sudden onset of fever, and other flu-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 of meningoencephalitis begin with the rash and continue into the second or third weeks. Other signs of meningoencephalitis include sensitivity to light (photophobia), altered mental status (delirium), or coma. Untreated cases are often fatal.

Meningoencephalitis central nervous system disease that involves encephalitis which occurs along with meningitis

Meningoencephalitis, also known as herpes meningoencephalitis, is a medical condition that simultaneously resembles both meningitis, which is an infection or inflammation of the meninges, and encephalitis, which is an infection or inflammation of the brain.

Photophobia is a symptom of abnormal intolerance to visual perception of light. As a medical symptom, photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical sensitivity of the eyes, though the term is sometimes additionally applied to abnormal or irrational fear of light such as heliophobia. The term photophobia comes from the Greek φῶς (phōs), meaning "light", and φόβος (phóbos), meaning "fear". Photophobia is a common symptom of visual snow.

Delirium Severe confusion that develops quickly, and often fluctuates in intensity, neurocognitive disorder

Delirium, also known as acute confusional state, is an organically-caused decline from a previously baseline level of mental function that develops over a short period of time. Delirium is not a disease itself, but a syndrome encompassing disturbances in attention, consciousness, and cognition. It may also involve other neurological deficits, like psychomotor disturbances, impaired sleep-wake cycle, emotional disturbances, and perceptual disturbances, although these features are not required for diagnosis.


Multiple diseases include the word "typhus" in their description. [11] Types include:

Epidemic louse-borne typhus Rickettsia prowazekii Body louse When the term "typhus" is used without clarification, this is usually the condition described. Historical references to "typhus" are now generally considered to be this condition.[ citation needed ]
Murine typhus or "endemic typhus" Rickettsia typhi Fleas on rats
Scrub typhus Orientia tsutsugamushi Harvest mites on humans or rodents
Queensland tick typhus [12] or "Australian tick typhus" (and a spotted fever [13] ) Rickettsia australis Ticks


As of 2017 there is no commercially available vaccine. [3] [4] [5] A vaccine has been in development for scrub typhus known as the scrub typhus vaccine. [14]


The American Public Health Association recommends treatment based upon clinical findings and before culturing confirms the diagnosis. [15] Without treatment, death may occur in 10 to 60 percent of patients with epidemic typhus, with patients over age 60 having the highest risk of death.[ citation needed ] In the antibiotic era, death is uncommon if doxycycline is given. In one study of 60 hospitalized patients with epidemic typhus, no patient died when given doxycycline or chloramphenicol. [16] Some patients also may need oxygen and intravenous (IV) fluids.


According to the World Health Organization, the current death rate from typhus is about one out of every 5,000,000 people per year. [17]

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. [18] [19] [20] [21]

Except for two cases, all instances of epidemic typhus in the United States have occurred east of the Mississippi River. An examination of a cluster of cases in Pennsylvania concluded the source of the infection was flying squirrels. [22] Sylvatic cycle (diseases transmitted from wild animals) epidemic typhus remains uncommon in the US. The Centers for Disease Control and Prevention have documented only 47 cases from 1976 to 2010. [23] An outbreak of flea-borne typhus was identified in downtown Los Angeles, California in October 2018 that was larger than their usual number of typhus cases. [24]


Middle Ages

The first reliable description of the disease appears in 1489 AD during the Spanish siege of Baza against the Moors during the War of Granada (1482–1492). These accounts include descriptions of fever; red spots over arms, back, and chest; attention deficit, progressing to delirium; as well as gangrenous 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. [25]

Gaol Fever

In historical times "Gaol Fever", or "Aryotitus fever"[ citation needed ] 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. [26] Following the assizes held at Oxford in 1577, later deemed the Black Assize, over 300 died from gaol fever, including Sir Robert Bell, Lord Chief Baron of the Exchequer. The Black Assize of Exeter 1586 was another notable outbreak. During the Lent assizes court held at Taunton in 1730, gaol fever caused the death of the Lord Chief Baron, as well as the High Sheriff, the sergeant, and hundreds of others. During a time when persons were executed for capital offenses, 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. [26] In London, gaol fever frequently broke out among the ill-kept prisoners of Newgate Prison and then moved into the general city population. In May 1750, the Lord Mayor of London, Sir Samuel Pennant, and a large number of court personnel were fatally infected in the courtroom of the Old Bailey, which adjoined Newgate Prison. [27]

Epidemics occurred routinely throughout Europe from the 16th to the 19th centuries, including during the English Civil War, the Thirty Years' War, and the Napoleonic Wars. [28] Pestilence of several kinds raged among combatants and civilians in Germany 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." [29]

19th century

During Napoleon's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians. [30]

A major epidemic occurred in Ireland between 1816 and 1819, during the famine caused by a worldwide reduction in temperature known as the Year Without a Summer. An estimated 100,000 people perished. Typhus appeared 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, as lice were endemic and inescapable, but it hit particularly hard in the lower or "unwashed" social strata.

In the United States, a typhus epidemic broke out in Philadelphia in 1837 and killed the son of Franklin Pierce (14th President of the United States) in Concord, New Hampshire, in 1843. Several epidemics occurred in Baltimore, Memphis and Washington, D.C. between 1865 and 1873. Typhus 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 fever, caused by the bacterium Salmonella typhii (not to be confused with Salmonella enterica, the cause of salmonella food poisoning), is a completely different disease from typhus.

In Canada alone, the typhus epidemic of 1847 killed more than 20,000 people from 1847 to 1848, mainly Irish immigrants in fever sheds and other forms of quarantine, who had contracted the disease aboard the crowded coffin ships in fleeing the Great Irish Famine. Officials neither knew how to provide sufficient sanitation under conditions of the time nor understood how the disease spread. [31]

The clipper Ticonderoga  was infamous for her "fever ship" voyage from Liverpool to  Port Phillip  carrying 795 passengers in 1852. The overcrowded ship was not designed well for passenger carrying, sanitary provisions were inadequate, and the ship's doctors were soon overwhelmed. During the voyage, 100 passengers died of what was later determined to have been typhus.[ citation needed ]

20th century

Delousing stations were established for troops on the Western Front during World War I, but the disease ravaged the armies of the Eastern Front, with over 150,000 dying in Yugoslavia 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.

In 1922, the typhus epidemic reached its peak in Soviet territory, with some 25 to 30 million cases in Russia. Although typhus had ravaged Poland 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 as Hélène Sparrow and Rudolf Weigl. [32] In Russia, during the civil war between the White and Red Armies, typhus killed 3 million people, [33] [34] mainly civilians.

During World War II, many German POWs after the loss at Stalingrad died of typhus. Typhus epidemics killed those confined to POW camps, ghettos, and Nazi concentration camps who were held in unhygienic conditions. Pictures of mass graves including people who died from typhus can be seen in footage shot at Bergen-Belsen concentration camp. [35]

Among thousands of prisoners in concentration camps such as Theresienstadt and Bergen-Belsen who died of typhus [35] were Anne Frank, age 15, and her sister Margot, age 19. Major epidemics in the post-war chaos of Europe were averted only by widespread use of the newly discovered DDT to kill the lice on millions of refugees and displaced persons.

The first typhus vaccine was developed by the Polish zoologist Rudolf Weigl in the interwar period. [36] Better, less-dangerous and less-expensive vaccines were developed during World War II. Since then, some epidemics have occurred in Asia, Eastern Europe, the Middle East, and parts of Africa.[ citation needed ]

21st century

Beginning in 2018, a typhus outbreak of more than the usual number of cases has spread through Los Angeles County primarily affecting homeless people. [37] In 2019 city attorney Elizabeth Greenwood revealed that she too was infected with typhus as a result of a flea bite at her office in Los Angeles City Hall which resulted in her going on medical leave. [38] [39]

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