View source for Typhus

{{Short description|Group of infectious diseases}}
{{Other uses|Typhus (disambiguation)}}
{{Distinguish|Typhoid fever}}
{{Use British English|date=November 2013}}
{{Use dmy dates|cs1-dates=ll|date=October 2024}}
{{cs1 config|name-list-style=vanc}}
{{Infobox medical condition (new)
| name            = Typhus
| synonyms        = Typhus fever
| image           = Epidemic typhus Burundi.jpg
| caption         = Rash caused by epidemic typhus
| field           = [[Infectious disease]]
| symptoms        = Fever, headache, rash<ref name="CDC2017In" />
| onset           = 1–2 weeks after exposure<ref name="CDC2017He" />
| duration        =
| causes          = Bacterial infection spread by [[parasites]]<ref name="CDC2017In" />
| complications   = [[Meningoencephalitis]]
| risks           =  Poor sanitation
| diagnosis       =
| differential    =
| prevention      =  Avoiding exposure to organisms known to carry the disease
| treatment       = [[Doxycycline]]<ref name="CDC2017He" />
| medication      =
| frequency       = Rare<ref name="CDC2017Epi" />
| deaths          =
}}
<!-- Definition and symptoms -->
'''Typhus''', also known as '''typhus fever''', is a group of [[infectious diseases]] that include [[epidemic typhus]], [[scrub typhus]], and [[murine typhus]].<ref name="CDC2017In" /> Common symptoms include fever, headache, and a rash.<ref name="CDC2017In">{{cite web |title=Typhus Fevers |website=CDC.gov |publisher=[[Centers for Disease Control and Prevention]] |date=7 March 2017 |url= https://www.cdc.gov/typhus/index.html |url-status=live |access-date=26 March 2017 |archive-url= https://web.archive.org/web/20170326231028/https://www.cdc.gov/typhus/index.html |archive-date=26 March 2017}}</ref> Typically these begin one to two weeks after exposure.<ref name="CDC2017He" />
<!-- Cause and diagnosis -->
The diseases are caused by specific types of [[bacterial infection]].<ref name="CDC2017In" /> Epidemic typhus is caused by ''[[Rickettsia prowazekii]]'' spread by [[body lice]], scrub typhus is caused by ''[[Orientia tsutsugamushi]]'' spread by [[chiggers]], and murine typhus is caused by ''[[Rickettsia typhi]]'' spread by [[fleas]].<ref name="CDC2017In" />
<!-- Prevention, treatment, epidemiology -->
[[Vaccine]]s have been developed, but none are commercially available.<ref name="CDC2017Epi" /><ref name="CDC2017Scu" /><ref name="CDC2017Mu" /> Prevention is achieved by reducing exposure to the organisms that spread the disease.<ref name="CDC2017Epi">{{cite web |title=Epidemic Typhus {{!}} Typhus Fevers |website=CDC.gov |publisher=[[Centers for Disease Control and Prevention]] |date=7 March 2017 |url= https://www.cdc.gov/typhus/epidemic/index.html |url-status=live |access-date=27 March 2017 |archive-url= https://web.archive.org/web/20170326230950/https://www.cdc.gov/typhus/epidemic/index.html |archive-date=26 March 2017}}</ref><ref name="CDC2017Scu">{{cite web |title=Scrub Typhus |website=CDC.gov |publisher=[[Centers for Disease Control and Prevention]] |date=7 March 2017 |url= https://www.cdc.gov/typhus/scrub/index.html |url-status=live |access-date=26 March 2017 |archive-url= https://web.archive.org/web/20170326230903/https://www.cdc.gov/typhus/scrub/index.html |archive-date=26 March 2017}}</ref><ref name="CDC2017Mu">{{cite web |title=Murine Typhus |website=CDC.gov |publisher=[[Centers for Disease Control and Prevention]] |url= https://www.cdc.gov/typhus/murine/index.html |url-status=live |access-date=26 March 2017 |archive-url= https://web.archive.org/web/20170326230521/https://www.cdc.gov/typhus/murine/index.html |archive-date=26 March 2017}}</ref> Treatment is with the antibiotic [[doxycycline]].<ref name="CDC2017He">{{cite web |title=Information for Health Care Providers {{!}} Typhus Fevers |website=CDC.gov |publisher=[[Centers for Disease Control and Prevention]] |date=7 March 2017 |url= https://www.cdc.gov/typhus/healthcare-providers/index.html |url-status=live |access-date=26 March 2017 |archive-url= https://web.archive.org/web/20170327075824/https://www.cdc.gov/typhus/healthcare-providers/index.html|archive-date=27 March 2017}}</ref> Epidemic typhus generally occurs in [[outbreaks]] when poor sanitary conditions and crowding are present.<ref>{{cite web |title=Typhus |url= https://www.who.int/mediacentre/factsheets/fs162/en/ |website=WHO.int |publisher=[[World Health Organization]] |date=May 1997 |archive-url= https://web.archive.org/web/20170327080029/http://www.who.int/mediacentre/factsheets/fs162/en/ |archive-date=27 March 2017}}</ref> While once common, it is now rare.<ref name="CDC2017Epi" /> Scrub typhus occurs in [[Southeast Asia]], [[Japan]], and northern [[Australia]].<ref name="CDC2017Scu" /> Murine typhus occurs in [[tropical]] and [[subtropical]] areas of the world.<ref name="CDC2017Mu" />
<!-- History and culture -->
Typhus has been described since at least 1528.<ref name="Ben2014" /> The name comes from the [[Ancient Greek|Greek]] {{lang|grc-Latn|tûphos}} ({{Wikt-lang|grc|τῦφος}}), meaning 'hazy' or 'smoky' and commonly used as a word for delusion, describing the state of mind of those infected.<ref name="Ben2014">{{cite book |vauthors=Bennett JE, Dolin R, Blaser MJ |title=Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases E-Book |date=2014 |publisher=Elsevier Health Sciences |isbn=9780323263733 |page=2217 |url= https://books.google.com/books?id=73pYBAAAQBAJ&pg=PA2217 |url-status=live |archive-url= https://web.archive.org/web/20170910163706/https://books.google.com/books?id=73pYBAAAQBAJ&pg=PA2217 |archive-date=10 September 2017}}</ref> While ''typhoid'' means 'typhus-like', typhus and [[typhoid fever]] are distinct diseases caused by different types of bacteria, the latter by specific strains of ''Salmonella typhi''.<ref>{{cite book |vauthors=Evans AS, Brachman PS |title=Bacterial Infections of Humans: Epidemiology and Control |date=2013 |publisher=Springer |isbn=9781461553274 |page=839 |url= https://books.google.com/books?id=dPDdBgAAQBAJ&pg=PA839 |url-status=live |archive-url= https://web.archive.org/web/20170910163706/https://books.google.com/books?id=dPDdBgAAQBAJ&pg=PA839 |archive-date=10 September 2017}}</ref> However, in some languages such as [[German language|German]], the term {{lang|de|typhus}} does mean 'typhoid fever', and the here-described typhus is called by another name, such as the language's equivalent of 'lice fever'.
==Signs and symptoms==
These signs and symptoms refer to epidemic typhus, as it is the most important of the typhus group of diseases.<ref name="McGraw Hill">{{cite book |vauthors=Levinson W |title=Review of Medical Microbiology and Immunology |date=2010 |publisher=McGraw Hill |isbn=9780071700283 |edition=11th}}</ref>
Signs and symptoms begin with sudden onset of fever and other [[Influenza|flu]]-like symptoms about one to two weeks after being infected.<ref name="MullenDurden2002">{{cite book |vauthors=Mullen GR, Durden LA |title=Medical and Veterinary Entomology |url= https://books.google.com/books?id=6R1v9o-uaI4C&pg=PA58 |date=27 September 2002 |publisher=Academic Press |isbn=978-0-08-053607-1 |pages=58 ''ff.'' |url-status=live |archive-url= https://web.archive.org/web/20170910163706/https://books.google.com/books?id=6R1v9o-uaI4C&pg=PA58 |archive-date=10 September 2017}}</ref> 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.<sup>[''[[Wikipedia:Citation needed|citation needed]]'']</sup> Other signs of meningoencephalitis include sensitivity to light ([[photophobia]]), altered mental status ([[delirium]]), or coma. Untreated cases are often fatal.<ref>{{cite web |date=19 November 2019 |title=Herpes Meningoencephalitis |url= https://www.hopkinsmedicine.org/health/conditions-and-diseases/herpes-hsv1-and-hsv2/herpes-meningoencephalitis |access-date=31 October 2023 |website=www.hopkinsmedicine.org}}</ref>
Signs and symptoms of [[scrub 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 an [[eschar]]. More severe symptoms may damage the lungs, brain, kidney, meninges, and heart.<ref>{{cite journal |last1=Liu |first1=Xianghong |last2=Zhang |first2=Ye |last3=Zhang |first3=Jun |last4=Lou |first4=Zheng |last5=Xia |first5=Han |last6=Lu |first6=Zhijuan |date=2021 |title=The Early Diagnosis of Scrub Typhus by Metagenomic Next-Generation Sequencing |journal=Frontiers in Public Health |volume=9 |doi=10.3389/fpubh.2021.755228 |pmid=34858931 |issn=2296-2565 |doi-access=free |pmc=8632043}}</ref>
==Causes==
Multiple diseases include the word "typhus" in their descriptions.<ref>{{cite book |vauthors=Eremeeva ME, Dasch GA |chapter=Rickettsial (Spotted & Typhus Fevers) & Related Infections (Anaplasmosis & Ehrlichiosis) |chapter-url= http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/rickettsial-spotted-and-typhus-fevers-and-related-infections-anaplasmosis-and-ehrlichiosis |url-status=live |archive-url= https://web.archive.org/web/20140517135719/http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/rickettsial-spotted-and-typhus-fevers-and-related-infections-anaplasmosis-and-ehrlichiosis |archive-date=17 May 2014 |title=CDC health Information for International Travel 2014: The Yellow Book |date=2014 |publisher=[[Centers for Disease Control and Prevention]] |location=New York |isbn=978-0-19-994850-5}}</ref> Types include:
{| class="wikitable plainrowheaders"
! scope="col" | Condition
! scope="col" | Bacterium
! scope="col" | Reservoir/vector
! scope="col" | Notes
|-
! scope="row" | [[Epidemic typhus|Epidemic louse-borne typhus]]
| ''[[Rickettsia prowazekii]]''
| [[Body louse]]
| 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|date=December 2017}}
|-
! scope="row" | [[Murine typhus]] or "endemic typhus"
| ''[[Rickettsia typhi]]''
| [[Flea]]s on [[rat]]s
|
|-
! scope="row" | [[Scrub typhus]]
| ''[[Orientia tsutsugamushi]]''
| [[Harvest mite]]s on [[human]]s or [[rodent]]s
|
|-
! scope="row" | [[Spotted fever]]
| [[Rickettsia#Spotted fever group|''Rickettsia'' spotted fever group]]
| [[Tick]]s
| Includes [[Boutonneuse fever]], [[Rocky Mountain spotted fever]], [[Queensland tick typhus]] and other variants.
|}
== Diagnosis ==
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.<ref>{{cite web |date=29 March 2021 |title=Typhus fevers for healthcare providers |website=CDC.gov |publisher=[[Centers for Disease Control and Prevention]] |url= https://www.cdc.gov/typhus/healthcare-providers/index.html |access-date=19 October 2023}}</ref>
==Prevention==
As of 2024, no vaccine is commercially available.<ref name="CDC2017Epi" /><ref name="CDC2017Scu" /><ref name="CDC2017Mu" /> A vaccine has been in development for scrub typhus known as the [[scrub typhus vaccine]].<ref>{{cite journal |vauthors=Chattopadhyay S, Richards AL |title=Scrub typhus vaccines: past history and recent developments |journal=Human Vaccines |volume=3 |issue=3 |pages=73–80 |date=2007 |pmid=17375000 |doi=10.4161/hv.3.3.4009 |doi-access=free}}</ref>
=== Scrub typhus ===
[[Scrub typhus]] is caused by mites, so avoid the outdoors when scrub is common in the area. Make sure your clothing is treated with [[permethrin]] to prevent mite bites. Lastly, make sure to use bug spray to keep mites away as well. For children and babies, you additionally have to make sure their clothing covers their limbs. For babies put a mosquito cover over their stroller which also protects them from mites.<ref>{{cite web |date=13 November 2020 |title=Scrub typhus |website=CDC.gov |publisher=[[Centers for Disease Control and Prevention]] |url= https://www.cdc.gov/typhus/scrub/index.html |access-date=19 October 2023}}</ref>
=== Epidemic typhus ===
[[Epidemic typhus]] is caused by body lice and thrives in areas with overcrowding. To avoid lice you should stay away from highly populated areas. 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, treat clothing with [[permethrin]] because it helps kill lice.<ref name="CDC2017Epi" />
=== Murine typhus ===
[[Murine typhus]] is caused by flea bites so take steps to avoid fleas. This can be done by making sure pets do not have fleas and if they do, treat them, stay away from wild animals, use insect repellent to keep fleas away, and wear gloves when dealing with sick or dead animals. Take steps to ensure rodents or other wildlife do not get into your home.<ref>{{cite web |date=3 August 2023 |title=Flea-borne (murine) typhus |website=CDC.gov |publisher=[[Centers for Disease Control and Prevention]] |url= https://www.cdc.gov/typhus/murine/index.html |access-date=19 October 2023}}</ref>
==Treatment==
The [[American Public Health Association]] recommends treatment based upon clinical findings and before culturing confirms the diagnosis.<ref>{{cite book |vauthors=Heymann D |title=Control of communicable diseases manual : an official report of the American Public Health Association |publisher=APHA Press, an imprint of the American Public Health Association |pages=661–668 |location=Washington, DC |date=2015 |isbn=9780875530185}}</ref> 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.<ref>{{cite web |title=Department of Agriculture {{!}} Typhus Fever - Rickettsia prowazekii |url= https://www.nj.gov/agriculture/divisions/ah/diseases/typhus.html |access-date=14 September 2023 |website=www.nj.gov}}</ref>  In the antibiotic era, death is uncommon if [[doxycycline]] is given. In one study of 60 people hospitalized with epidemic typhus, no one died when given doxycycline or [[chloramphenicol]].<ref>{{cite journal |vauthors=Matossian RM, Thaddeus J, Garabedian GA |title=Outbreak of epidemic typhus in the northern region of Saudi Arabia |journal=The American Journal of Tropical Medicine and Hygiene |volume=12 |pages=82–90 |date=January 1963 |pmid=13933690 |doi=10.4269/ajtmh.1963.12.82}}</ref>
==Epidemiology==
According to the [[World Health Organization]], in 2010 the death rate from typhus was about one  of every 5,000,000 people per year.<ref>[https://www.who.int/whosis/en/ WHO Statistical Information System (WHOSIS)] {{webarchive|url= https://web.archive.org/web/20100221035844/http://www.who.int/whosis/en/ |date=21 February 2010 }}</ref>
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.<ref>{{cite journal |vauthors=Raoult D, Roux V, Ndihokubwayo JB, Bise G, Baudon D, Marte G, Birtles R |title=Jail fever (epidemic typhus) outbreak in Burundi |journal=Emerging Infectious Diseases |volume=3 |issue=3 |pages=357–60 |date=1997 |pmid=9284381 |pmc=2627627 |doi=10.3201/eid0303.970313}}</ref><ref>{{cite journal |vauthors=Mokrani K, Fournier PE, Dalichaouche M, Tebbal S, Aouati A, Raoult D |title=Reemerging threat of epidemic typhus in Algeria |journal=Journal of Clinical Microbiology |volume=42 |issue=8 |pages=3898–900 |date=August 2004 |pmid=15297561 |pmc=497610 |doi=10.1128/jcm.42.8.3898-3900.2004}}</ref><ref>{{cite journal |vauthors= |title=Epidemic typhus risk in Rwandan refugee camps |journal=Relevé Épidémiologique Hebdomadaire |volume=69 |issue=34 |pages=259 |date=August 1994 |pmid=7947074}}</ref><ref>{{cite journal |vauthors=Perine PL, Chandler BP, Krause DK, McCardle P, Awoke S, Habte-Gabr E, Wisseman CL, McDade JE |display-authors=6 |title=A clinico-epidemiological study of epidemic typhus in Africa |journal=Clinical Infectious Diseases |volume=14 |issue=5 |pages=1149–58 |date=May 1992 |pmid=1600020 |doi=10.1093/clinids/14.5.1149}}</ref>
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 [[New World flying squirrel|flying squirrels]].<ref>{{cite journal |vauthors=Chapman AS, Swerdlow DL, Dato VM, Anderson AD, Moodie CE, Marriott C, Amman B, Hennessey M, Fox P, Green DB, Pegg E, Nicholson WL, Eremeeva ME, Dasch GA |display-authors=6 |title=Cluster of sylvatic epidemic typhus cases associated with flying squirrels, 2004-2006 |journal=Emerging Infectious Diseases |volume=15 |issue=7 |pages=1005–11 |date=July 2009 |pmid=19624912 |pmc=2744229 |doi=10.3201/eid1507.081305}}</ref> [[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.<ref>{{cite journal |vauthors=McQuiston JH, Knights EB, Demartino PJ, Paparello SF, Nicholson WL, Singleton J, Brown CM, Massung RF, Urbanowski JC |display-authors=6 |title=Brill-Zinsser disease in a patient following infection with sylvatic epidemic typhus associated with flying squirrels |journal=Clinical Infectious Diseases |volume=51 |issue=6 |pages=712–5 |date=September 2010 |pmid=20687836 |doi=10.1086/655891 |doi-access=free}}</ref> An outbreak of [[flea]]-borne murine typhus was identified in downtown [[Los Angeles, California]], in October 2018.<ref name="CBSLA">{{cite web |work=CBS Los Angeles |title=Downtown LA Hit With Outbreak Of Flea-Borne Typhus |url= https://losangeles.cbslocal.com/2018/10/04/downtown-la-skid-row-typhus-outbreak/ |date=4 October 2018}}</ref>
==History==
===Middle Ages===
The first reliable description of typhus appears in 1489 AD during the Spanish siege of [[Baza, Granada|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; and [[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.<ref>{{cite book |vauthors=Zinsser H |title=Rats, Lice and History |publisher=Bantam Classic |date=1960 |page=186 |author-link=Hans Zinsser |title-link=Rats, Lice and History}}</ref>
In historical times,{{when|date=September 2020}} "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.<ref name="Ralph D. Smith 1967">{{cite journal |vauthors=Smith RD |title=Criminal Law—Arrest—The Right to Resist Unlawful Arrest. |journal=Natural Resources Journal |date=January 1967 |volume=7 |issue=1 |pages=119–28}} (hereinafter Comment) (citing {{cite book |title=The State of the Prisons |vauthors=Howard J |publisher=J.M. Dent & Sons Ltd |pages=6–7 |date=1929}}) (Howard's observations are from 1773 to 1775). Copied from ''State v. Valentine'' (May 1997) 132 Wn.2d 1, 935 P.2d 1294</ref> 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 of the Exchequer|Lord Chief Baron]], as well as the [[High Sheriff of Somerset|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.<ref name="Ralph D. Smith 1967" /> 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 many court personnel were fatally infected in the courtroom of the [[Old Bailey]], which adjoined Newgate Prison.<ref>Gordon, Charles [https://archive.org/stream/cu31924030386662#page/n347/mode/2up The Old Bailey and Newgate] {{webarchive|url= https://web.archive.org/web/20160312092121/https://archive.org/stream/cu31924030386662 |date=12 March 2016 }} pp.331–2. T. Fisher Unwin, London, 1902</ref>
===Early modern epidemics===
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]].<ref>[http://www.time.com/time/magazine/article/0,9171,794989,00.html War and Pestilence] {{webarchive|url= https://web.archive.org/web/20090921004137/http://www.time.com/time/magazine/article/0,9171,794989,00.html |date=21 September 2009 }}. ''Time'' magazine</ref> Pestilence of several kinds raged among combatants and civilians in [[Holy Roman Empire|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."<ref>{{cite book |vauthors=Byrne JP |title=Encyclopedia of Pestilence, Pandemics, and Plagues: A—M |url= https://books.google.com/books?id=5Pvi-ksuKFIC&pg=PA732 |publisher=ABC-CLIO |date=2008 |page=732 |isbn=978-0-313-34102-1 |url-status=live |archive-url= https://web.archive.org/web/20140104153030/http://books.google.com/books?id=5Pvi-ksuKFIC&pg=PA732 |archive-date=4 January 2014}}</ref>
===19th century===
During [[Napoleon]]'s [[French invasion of Russia|retreat from]] [[Moscow]] in 1812, more French soldiers died of typhus than were killed by the Russians.<ref>[http://entomology.montana.edu/historybug/TYPHUS-Conlon.pdf The Historical Impact of Epidemic Typhus] {{webarchive|url= https://web.archive.org/web/20091106154259/http://entomology.montana.edu/historybug/TYPHUS-Conlon.pdf |date=6 November 2009 }}. Joseph M. Conlon.</ref>
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 Famine (Ireland)|Great Irish Famine]] between 1846 and 1849. The typhus outbreak along with [[typhoid fever]] is said to be responsible for 400,000 deaths.<ref>{{cite book |last=Ó Gráda |first=Cormac |title=Black '47 and Beyond: The Great Irish Famine in History, Economy, and Memory |publisher=[[Princeton University Press]] |date=1999 |pages=88}}</ref> 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.<ref>{{Citation |last1=Renvoise |first1=Aurélié |title=61 - Epidemic Louse-borne Typhus |date=1 January 2013 |url= https://www.sciencedirect.com/science/article/pii/B9781416043904000618 |work=Hunter's Tropical Medicine and Emerging Infectious Disease (Ninth Edition) |pages=535–538 |editor-last=Magill |editor-first=Alan J. |access-date=31 October 2023 |place=London |publisher=W. B. Saunders |isbn=978-1-4160-4390-4 |last2=Raoult |first2=Didier |editor2-last=Hill |editor2-first=David R |editor3-last=Solomon |editor3-first=Tom |editor4-last=Ryan |editor4-first=Edward T}}</ref>
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, Maryland|Baltimore]], [[Memphis, Tennessee|Memphis]], and [[Washington, DC]], between 1865 and 1873. Typhus was also a significant killer during the [[American Civil War|US Civil War]], although [[typhoid]] fever was the more prevalent cause of US Civil War "camp fever". Typhoid fever is caused by the bacterium ''Salmonella enterica Serovar Typhi''.<ref>{{cite journal |vauthors=Dougan G, Baker S |title=Salmonella enterica serovar Typhi and the pathogenesis of typhoid fever |journal=Annual Review of Microbiology |volume=68 |issue=1 |pages=317–36 |date=8 September 2014 |pmid=25208300 |doi=10.1146/annurev-micro-091313-103739 |doi-access=free}}</ref>
In [[Canada]] alone, the [[1847 North American typhus epidemic|typhus epidemic of 1847]] killed more than 20,000 people from 1847 to 1848, mainly Irish immigrants in [[fever shed]]s and other forms of quarantine, who had contracted the disease aboard the crowded [[coffin ship]]s in fleeing the [[Great Famine (Ireland)|Great Irish Famine]]. Officials neither knew how to provide sufficient sanitation under conditions of the time nor understood how the disease spread.<ref name="mccord1">{{cite web |title=M993X.5.1529.1 {{!}} The government inspector's office|url= http://www.mccord-museum.qc.ca/en/collection/artifacts/M993X.5.1529.1|work=[[McCord Museum]]|access-date=22 January 2012|location=[[Montreal]]|url-status=live|archive-url= https://web.archive.org/web/20110408035406/http://www.mccord-museum.qc.ca/en/collection/artifacts/M993X.5.1529.1|archive-date=8 April 2011}}</ref>
===20th century===
Typhus was [[Endemic typhus|endemic]] in [[Poland]] and several neighboring countries prior to [[World War I]] (1914–1918), but became [[Epidemic typhus|epidemic]] during the war.<ref>{{cite web |title=Health, Disease, Mortality; Demographic Effects {{!}} International Encyclopedia of the First World War (WW1)|url= https://encyclopedia.1914-1918-online.net/article/health_disease_mortality_demographic_effects|access-date=26 February 2021|website=encyclopedia.1914-1918-online.net}}</ref><ref>{{cite journal |vauthors=Goodall ES |date=23 April 1920 |title=Typhus Fever in Poland, 1916 to 1919. |journal=Section of Epidemiology and State Medicine |volume=13 |issue=Sect Epidemiol State Med |pages=261–276 |pmid=19981289 |pmc=2152684}}</ref><ref name=":0">{{cite web |title=Typhus, War, and Vaccines |url= https://www.historyofvaccines.org/content/blog/typhus-war-and-vaccines |access-date=26 February 2021 |website=History of Vaccines |archive-date=28 February 2021 |archive-url= https://web.archive.org/web/20210228050952/https://www.historyofvaccines.org/content/blog/typhus-war-and-vaccines |url-status=dead}}</ref> Delousing stations were established for troops on the [[Western Front (World War I)|Western Front]] during [[World War I]], but typhus ravaged the armies of the [[Eastern Front (World War I)|Eastern Front]], where over 150,000 died in [[Kingdom of Serbia|Serbia]] alone.<ref>{{cite journal |vauthors=Pennington H |title=The impact of infectious disease in war time: a look back at WW1 |journal=Future Microbiology |volume=14 |issue=3 |pages=165–168 |date=February 2019 |pmid=30628481 |doi=10.2217/fmb-2018-0323 |doi-access=free}}</ref> 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|date=November 2019}}
In 1922, the typhus epidemic reached its peak in Soviet territory, with some 20 to 30&nbsp;million cases in [[Russia]].<ref name=":6">{{cite journal |vauthors=Patterson KD |title=Typhus and its control in Russia, 1870-1940 |journal=Medical History |volume=37 |issue=4 |pages=361–81 |date=October 1993 |pmid=8246643 |pmc=1036775 |doi=10.1017/s0025727300058725}}</ref> Although typhus had ravaged [[Poland]] with some 4&nbsp;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]].<ref>Paul Weindling. ''International Health Organisations and Movements, 1918–1939''. [[Cambridge University Press]] 1995, p. 99.</ref> In Russia during the [[Russian Civil War|civil war]] between the [[White movement|White]] and [[Red Army|Red Armies]], epidemic typhus killed 2–3 million people, many of whom were civilians.<ref name=":0" /><ref name=":6" /><ref>{{cite book |first=Andrew W. |last=Artenstein |title=Vaccines: A Biography |publisher=Springer |date=2010 |page=250}}</ref><ref>{{cite book |first=David G. |last=Rempel |title=A Mennonite Family in Tsarist Russia and the Soviet Union, 1789–1923 |publisher=[[University of Toronto Press]] |date=2011 |page=249}}</ref> In 1937 and 1938, there was a typhus epidemic in [[Chile]].<ref>[https://apps.who.int/iris/handle/10665/235533|Typhus Fever in Chile]</ref> On 6 March 1939, Prime Minister of France [[Édouard Daladier]] stated to the French parliament, he would return 300,000 of the Spanish refugees fleeing from the 1938 [[Spanish Civil War]]; reasons included the typhus spread in the French refugee camps, as well as France's sovereign recognition of [[Francisco Franco]].<ref>{{cite news |work=[[Newsweek]] |title=Gen. Franco’s Victory Clinched by French–British Recognition |page=18 |date=6 March 1939 |url= https://archive.org/details/sim_newsweek-us_1939-03-06_13_10/page/18/mode/2up}}</ref>
During [[World War II]], many German POWs after the [[Battle of Stalingrad|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]].<ref name="IMT">{{cite book |url= https://www.loc.gov/rr/frd/Military_Law/pdf/NT_war-criminals_Vol-I.pdf |title=Trials of War Criminals Before the Nuernberg Military Tribunal |publisher=US Government Printing Office |volume=1 |date=1949 |access-date=19 May 2015 |pages=508–511 |url-status=live |archive-url= https://web.archive.org/web/20160304233602/http://www.loc.gov/rr/frd/Military_Law/pdf/NT_war-criminals_Vol-I.pdf |archive-date=4 March 2016}}</ref> Among thousands of prisoners in concentration camps such as [[Theresienstadt concentration camp|Theresienstadt]] and Bergen-Belsen who died of typhus<ref name="IMT" /> were [[Anne Frank]], age 15, and her sister [[Margot Frank|Margot]], age 19, in the latter camp.
The first typhus vaccine was developed by the [[Polish people|Polish]] [[zoologist]] [[Rudolf Weigl]] in the interwar period; the vaccine did not prevent the disease but reduced its mortality.<ref>{{cite book |first=Naomi |last=Baumslag |title=Murderous Medicine: Nazi Doctors, Human Experimentation, and Typhus |publisher=[[Greenwood Publishing Group]] |date=2005 |page=[https://archive.org/details/murderousmedicin0000baum/page/133 page 133]}}</ref>
<gallery widths="200px" heights="200px">
File:Charles Nicolle at microscope.jpg|[[Charles Nicolle]] received the 1928 [[Nobel Prize]] in Medicine for his identification of lice as the transmitter of epidemic typhus.
File:DDT WWII soldier.jpg|A US soldier is demonstrating [[DDT]] hand-spraying equipment. DDT was used to control the spread of typhus-carrying lice.
File:CPS141ratpoison.jpg|A [[Civilian Public Service]] worker distributes rat poison for typhus control in [[Gulfport, Mississippi]], around 1945.
</gallery>
===21st century===
Beginning in 2018, a typhus outbreak spread through [[Los Angeles County]] primarily affecting homeless people.<ref>{{cite news |vauthors=Grover J, Corral A |title=Typhus Epidemic Worsens in Los Angeles |url= https://www.nbclosangeles.com/investigations/Typhus-Epidemic-Worsens-in-Los-Angeles-505166301.html |access-date=9 February 2019 |work=NBC Southern California}}</ref> In 2019, city attorney Elizabeth Greenwood revealed that she, too, was infected with typhus as a result of a flea bite{{dubious|date=April 2024}} at her office in [[Los Angeles City Hall]].<ref>{{cite news |vauthors=Smith D |title=L.A. City Hall, overrun with rats, might remove all carpets amid typhus fears |url= https://www.latimes.com/local/lanow/la-me-ln-rats-in-city-hall-20190207-story.html |work=Los Angeles Times}}</ref><ref>{{cite news |author=City News Service |title=Amid Typhus Outbreak, LA City Hall Carpets May Be Ripped Out |url= https://www.nbclosangeles.com/news/local/Los-Angeles-City-Hall-Carpets-Ripped-Out-Typhus-Outbreak-505508291.html |access-date=12 February 2019 |work=NBC Southern California}}</ref>  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".<ref>{{cite news |vauthors=Braslow S |title=How the Homeless Ended Up Being Blamed for Typhus |url= https://www.lamag.com/citythinkblog/typhus-los-angeles-homeless/ |access-date=5 March 2021 |work=Los Angeles Magazine}}</ref> Over the past decade as well murine typhus cases have been rising with the highest number of cases being 171 in 2022.<ref>{{cite journal |last=Alarcón |first=Jemma |date=2023 |title=Fleaborne Typhus–Associated Deaths — Los Angeles County, California, 2022 |url= https://www.cdc.gov/mmwr/volumes/72/wr/mm7231a1.htm |journal=Morbidity and Mortality Weekly Report |volume=72 |issue=31 |pages=838–843 |doi=10.15585/mmwr.mm7231a1 |pmid=37535465 |pmc=10414999 |issn=0149-2195}}</ref>
== References ==
{{Reflist}}
{{Medical condition classification and resources
| DiseasesDB = 29240
| ICD10 = {{ICD10|A|75 || a|75}}
| ICD9 = {{ICD9|080}}–{{ICD9|083}}
| ICDO =
| OMIM =
| MedlinePlus = 001363
| eMedicineSubj = med
| eMedicineTopic = 2332
| MeshID = D014438
}}
{{Gram-negative proteobacterial diseases}}
{{Authority control}}
[[Category:Typhus| ]]
[[Category:Rickettsioses]]
[[Category:Wikipedia infectious disease articles ready to translate]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Vaccine-preventable diseases]]