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Typhus

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. more...

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Typhus is a name given to several similar diseases caused by Rickettsia bacteria. It comes from the Greek typhos, meaning smoky or hazy, describing the state of mind of those affected with typhus. Symptoms common to all forms of typhus are a fever which may reach 39°C (102°F) and a headache. In tropical countries, typhus is often mistaken for dengue.

There are three types of typhus:

  • Epidemic typhus (also called "louse-bourne 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" and as "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, 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.

Definitive diagnosis can be obtained by serological testing ( the Weill 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.

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.

Typhim Vi is an intramuscular killed-bacteria vaccination and Vivotif is an oral live bacteria vaccination, both of which protect against typhoid fever. Neither vaccine is 100% effective against typhoid fever and neither of these vaccinations have any protection against unrelated typhus.

In the past, typhus was sometimes refered to as Petechial Fever, but this term could also refer to other diseases.

Read more at Wikipedia.org


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Typhus
From Gale Encyclopedia of Medicine, 4/6/01 by Rosalyn S. Carson-DeWitt

Definition

Several different illnesses called "typhus" exist, 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 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 carries the bacteria) are scratched into the wound. Body lice are common in areas where 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 which encourage the maintenance of a population of lice living among humans. 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 having 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 & 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%.

Prevention

Prevention for each of these forms of typhus includes avoidance of the insects which 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.
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.

Further Reading

For Your Information

    Books

  • Walker, David, et al. "Rickettsial Diseases." In Harrison's Principles of Internal Medicine,14th ed., edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.

    Organizations

  • Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (404) 332-4559. http://www.cdc.gov.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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