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Magill’s Medical Guide, 9th Edition

Typhus

by Michael A. Buratovich, PhD

Category: Disease/Disorder

Also known as: Epidemic typhus, rickettsiosis

Anatomy or system affected: Circulatory system, kidneys, nervous system, respiratory system, skin

Specialties and related fields: Bacteriology, environmental health, epidemiology, internal medicine, public health

Definition: An acute, systemic, febrile disease caused by bacteria that are transmitted through the bite of a body louse.

CAUSES AND SYMPTOMS

The causative agent of epidemic typhus is the bacterium Rickettsia prowazekii, an obligate intracellular parasite. These bacteria are transmitted to humans following the bite from an infected human body louse, Pediculus humanus.

Human body lice live on human skin and clothes. They lay their eggs on clothes, and these eggs hatch in approximately eight days. Lice larvae molt three times before they become adults, and they take a blood meal during each stage. Lice become infected with R. prowazekii by taking in blood from an infected person. The rickettsiae infect the stomach lining cells of the lice and appear in the feces of infected lice five days after their initial infection. Infected lice do not pass the rickettsiae to their progeny. After taking a blood meal, the lice defecate R. prowazekii-laden feces. The rickettsiae invade the site of a louse bite when the host scratches the bite or through injured skin. Lice feces remain infectious for as long as 100 days. Therefore, sharing clothes can transfer infective lice feces from one person to another.

Once in the body, R. prowazekii spreads through the bloodstream and lymphatic system. The rickettsiae invade the endothelial cells that line blood vessels and divide within them. They damage the endothelial cells and elicit vascular inflammation (vasculitis). The damage to capillary beds can harm the heart, muscle, spleen, kidneys, and brain.

The onset of the disease is marked by a high and prolonged fever, accompanying headache, heavy breathing, and rash. The rash begins on the trunk and spreads to the extremities. Less common symptoms include chills, muscle tenderness, abdominal tenderness, joint pain (arthralgias), cough, and nausea. Many epidemic typhus patients have central nervous system manifestations, including confusion and drowsiness. Some patients may even suffer from seizures, coma, or perceptual impairments. Mortality can be as high as 40 to 60 percent in untreated cases.

Years after recovering from epidemic typhus, some patients experience a recrudescent condition called “Brill-Zinsser disease.” This condition is usually mild and is characterized by the abrupt onset of chills, headache, fever, and tiredness (malaise). Elderly patients may become confused, short of breath (dyspnea), or have lethargy.

TREATMENT AND THERAPY

Diagnosis of epidemic typhus is primarily through serological tests. Indirect immunofluorescence antibody tests and immunoblot techniques are the main tests used to detect antibodies against R. prowazekii. These tests are available at most state health departments, the US Centers for Disease Control and Prevention (CDC), and specialized research laboratories. The polymerase chain reaction (PCR) tests effectively detect R. prowazekii deoxyribonucleic acid (DNA) from blood or the initial bite site and are available through the CDC.

Information on Typhus

Causes: Bacteria transmitted through lice bites

Symptoms: Fever, headache, rash

Duration: Acute

Treatments: Antibiotics

Antibiotic treatment is essential for reducing the severity of the disease. Tetracyclines and chloramphenicol are the most effective treatments for epidemic typhus. Doxycycline is the antibiotic of choice, and treatment should last seven to ten days. For prophylactic purposes, one 200 mg dose of doxycycline once weekly while in an endemic area and for one week after leaving the area effectively protects against epidemic typhus.

Improved sanitation and living conditions since the 1920s have virtually eliminated this disease in countries such as the United States. The last US epidemic was in 1922. Since then, there have been sporadic reports of isolated cases involving transmission from flying squirrels, which serve as animal reservoirs for R. prowazekii. The squirrel flea (Orchospea howardii) and the squirrel louse (Neohaemotophinus sciuropteri) are transmission vectors for R. prowazekii among flying squirrels. O. howardii can bite humans and transmit R. prowazekii between squirrels and humans. Epidemic typhus persists in some regions of Africa, Central America, and South America. During the civil war in Burundi, more than 45,000 cases of epidemic typhus occurred. In 2012, an epidemic typhus outbreak occurred at a youth center in Rwanda.

The best course of action for prevention is to practice good hygiene and sanitation and avoid areas where there might be rat fleas and lice. Permethrin treatment of bedding or clothing kills lice and remains effective even after twenty washings and is the best available delousing agent.

PERSPECTIVE AND PROSPECTS

Epidemic typhus, also known as “jail fever,” is primarily a disease of crowded, substandard living conditions and poor sanitation. Millions of cases occurred in the trenches of World War I and the concentration camps of World War II. Anne Frank, the noted teenage diarist, died of typhus contracted while at a concentration camp. It has been said that a louse started Napoleon’s retreat from Russia and that lice have defeated the most powerful armies of Europe and Asia.

The pioneering investigations of Howard Taylor Ricketts and Stanislas von Prowazeck in the early twentieth century paved the way for discovering both the bacteria and the louse vector. However, both men died from the disease that they studied. They were honored posthumously when the bacterium was named Rickettsia prowazekii.

See also Antibiotics; Bacterial infections; Bacteriology; Bites and stings; Epidemics and pandemics; Fever; Insect-borne diseases; Lice, mites, and ticks; Microbiology; Parasitic diseases; Zoonoses.

For Further Information:

1 

Angelakis, E., et al. “The History of Epidemic Typhus.” Microbiology Spectrum, vol. 4, no. 4, 2016, 10.1128/microbiolspec.PoH-0010-2015, doi:10.1128/microbiolspec.PoH-0010-2015.

2 

Center for Disease Control and Prevention. Epidemic Typhus, 13 Nov. 2020, www.cdc.gov/typhus/epidemic/index.html.

3 

Murray, Patrick R., Ken S. Rosenthal, and Michael A. Pfaller. Medical Microbiology. 9th ed., Mosby/Elsevier, 2020.

4 

Talty, Stephen, The Illustrious Dead: The Terrifying Story of How Typhus Killed Napoleon’s Greatest Army. Crown, 2009.

5 

Tortora, Gerard J., et al. Microbiology: An Introduction. 13th ed., Pearson, 2018.

6 

“Typhus.” MedlinePlus, medlineplus.gov/ency/article/001363.htm.

7 

Zinsser, Hans. Rats, Lice, and History. Black Dog & Leventhal, 1996.

Citation Types

Type
Format
MLA 9th
Buratovich, Michael A. "Typhus." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_1406.
APA 7th
Buratovich, M. A. (2022). Typhus. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Buratovich, Michael A. "Typhus." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed October 22, 2025. online.salempress.com.