Typhus

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This is about the disease Typhus. See Typhus (monster) for the monster in Greek mythology, or typhoid fever for an unrelated disease with a similar name.

**Typhus**
*Classifications and external resources*
ICD-10	A75
ICD-9	082-083

Typhus is any one of several similar diseases caused by Rickettsia bacteria. The name comes from the Greek typhos, meaning smoky or hazy, describing the state of mind of those affected with typhus.

Rickettsia is endemic in rodent hosts, including mice and rats, and spreads to humans through mites, fleas and head, body, and pubic lice. The insects often flourish under conditions of poor hygiene, such as those found in prisons or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field.

There are three types of typhus:

Epidemic typhus (also called "louse-borne typhus") often causes epidemics, following wars and natural disasters. The causative organism is Rickettsia prowazekii, transmitted by the human body louse (Pediculus humanus corporis). Symptoms are headache, fever, chills, exhaustion, and rash. This form of typhus is also known as "prison fever" or "ship fever", because it becomes prevalent in crowded conditions in prisons and aboard ships.
Endemic typhus (also called "flea-borne typhus" and "murine typhus") is caused by Rickettsia typhi, transmitted by fleas infesting rats, and, less often, Rickettsia felis, transmitted by fleas carried by cats or possums. Symptoms include headache, fever, chills, joint pain, loss of appetite, nausea, vomiting, and cough.
Scrub typhus (also called "chigger-borne typhus") is caused by Orientia tsutsugamushi and transmitted by chiggers, which are found in areas of heavy scrub vegetation. Symptoms include fever, headache, muscle pain, cough, and gastrointestinal symptoms.

Symptoms common to all forms of typhus are a fever which may reach 39 °C (102 °F) and a headache. Definitive diagnosis can be obtained by serological testing ( the Weil-Felix test). Treatment is often with tetracycline or related antibiotics.

There are a number of other diseases caused by Rickettsiae, including Rocky Mountain spotted fever (also known as "tick typhus"), Rickettsialpox and Boutonneuse fever. In tropical countries, typhus is often mistaken for dengue fever. In the past, typhus was sometimes referred to as Petechial Fever,[1] but this term could also refer to other diseases.

Typhoid fever is a completely different disease caused by various strains of Salmonella, and should not be confused with typhus despite their similar-sounding names.

[edit] Typhus in history

The city-state of Athens in ancient Greece was hit by a devastating epidemic, known as the Plague of Athens, during the second year of the Peloponnesian War (430 BC), 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 one of the strongest candidates for the cause of this disease outbreak, supported by both medical and scholarly opinions. At a January 1999 medical conference at the University of Maryland, Dr. David Durack, consulting professor of medicine at Duke University note: "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."[2] This medical opinion is supported by A. W. Gomme, a researcher and interpretator of Thucydides' history, who also believed typhus was the cause of the epidemic.

Typhus also arrived in Europe with soldiers who had been fighting on the isle of 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 stink of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action but an additional 17,000 died of typhus.

Combatant deaths due to typhus were obviously a serious factor during four centuries of European conflict. Major outbreaks occurred during the liberation of Spain, the English Civil War, the Thirty Years' War, and during Napoleon's failure in Russia. In World War I, de-lousing 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. Some historians assert that the disease may serve as a model for the use of biological weapons while in the field. Thousands of prisoners held in appalling conditions in Nazi concentration camps such Theresienstadt and Bergen-Belsen died of typhus during World War II, including Anne Frank.

Typhus was also a killer in civilian populations throughout history. In London, typhus frequently broke out among the ill-kept prisoners of Newgate Gaol and then moved into the general city population. An outbreak in 1557–59 killed about 10 percent of the English population. A major epidemic occurred in Ireland between 1816-19, which soon spread to England. In Russia after World War I, in the civil war between the White and Red armies, typhus killed three million, largely civilians.

[edit] References

Gomme, A. W., edited by A. Andrewes and K. J. Dover. An Historical Commentary on Thucydides, Volume 5. Book VIII Oxford University Press, 1981. ISBN 0-19-814198-X.
Gray, Michael W. Nature 396, 109 - 110 (12 November 1998).
Zinsser, Hans. "Rats, Lice and History: A Chronicle of Pestilence and Plagues." Originally published in Boston in 1935, later edition in 1963. Most recent edition 1996, Black Dog & Leventhal Publishers, New York. ISBN 1-884822-47-9.