A disease of many names
Typhus, also known as typhus fever, jail fever, scrub fever, Hospital fever, and Famine fever
, is a common disease in areas where humans and mice/rats reside in close proximity. The disease is rare in the US.
I've been around for many a year, laid many a soul to waste
Typhus has a long history in human experience, being first decribed in 1083 in a convent near Salerno, Italy.
Long before that, during the second year of the Peloponnesian War in 430 BC, Athens was hit by a plague which devasted the population. Among the victims were Pericles and his two eldest sons. Analysis by both medical historians and scholars name epidemic typhus as a strong contender for the cause.
In 1489 the Spanish laid seige to Moorish Grenada. During the war, the Spanish lost 3,000 men in conflict and an additional 17,000 to typhus.
In the deplorable conditions common in jails and prisons during much of history, typhus took its toll. Prisoners were jammed into disgusting hygenic conditions which, with the accompanying rodents, led to a virtual smorgasbord for the disease. Not only were the prisoners fair game, but the courts themselves, (including judges, sheriffs, and audiences), were afflicted. It was not uncommon for 25% of the prisoner population to die from typhus each year. In many cases, more criminals died from incarceration than by the gallows or other means of capital punishment.
During war, many prisoners were held in conditions little changed from the jails of medieval Europe. Poor diet, close quarters, lack of even basic sanitation, and co-existence with the rodent population were ideal conditions for typhus. Tens of thousand died of typhus in many outbreaks. The famed de-lousing stations were not for the comfort of the prisoners, but a means to attempt to supress typhus infection. During imprisonment in a concentration camp, Anne Frank and her sister Margot were both felled by typhus.
Not just prisoners, but those who imprisoned them were afflicted. During WW I, typhus accounted for 3 million Russian deaths, and more died from other nations. World War II saw the German Army struck in its charge into Russia in 1941. There were major outbreaks in French North Africa, Egypt, and Iran as well.
Home, sweet home
Typhus, of which there are three types, is caused by a bacterium. The bacterium makes its way into the digestive system of fleas, lice, or chiggers and multiply there, passing out in the feces of the host. When a human is bitten by an infected host, the disease isn't transmitted directly in the saliva. The carrier leaves its droppings which get into the bite or secondary damage site caused by scratching.
Typhus is not spread from person to person but is rather transmitted by being bitten by infected fleas/lice/chiggers, which become infected by biting infected rodents.
The incubation period for the disease is 1-2 weeks, with symptoms appearing usually by day 12 after exposure. Symptoms include high fever, chills, headache, cough, and general pains which are followed by a characteristic rash which covers the body with the exception of the face, palms, and soles of the feet.
Three deadly sisters
Flea-borne typhus is similar but less severe than its louse-borne relative. Flea-borne typhus, (Rickettsia typhi), is also known as endemic typhus or murine typhus.
The louse-borne variant, (Rickettsia prowazekii), is known as epidemic typhus and also as Brill-Zinsser disease. Brill-Zinsser disease is a mild form of epidemic typhus where the disease reactivates in a person who has previously had the disease. The condition is usually found among the elderly. Epidemic typhus is the most lethal and accounts for the vast majority of typhus deaths.
The chigger-borne variant of typhus, known as scrub typhus is caused by Orientia tsutsugamushi, a bacterium in the family Rickettsiaceae, and occurs mainly in Asia. The name comes from the habitat chiggers favor, the scrub brush areas where they attach themselves to an available host.
Diagnosis and treatment
Diagnosis of the disease is generally by blood tests. Treatment is usually a course of tetracycline and chloramphenicol.
Death from endemic typhus will occur in up to 2% of the untreated population, while exposure to epidemic typhus will lead to death in 10-60% of untreated persons. Scrub typhus comes in at a strong second place with a mortality of from 5-40% of untreated cases.
Typhus can also lead to secondary diseases including encephalitis, pneumonia, delirium, conjunctival complication, hypotension, renal insufficiency, and cardiac involvement. It is important to seek medical attention if symptoms are displayed as severe symptoms and death can occur without proper care.
Prevent, prevent, prevent!
As with any disease, prevention is the best policy. Utilize an effective rodent control program which also helps supress the flea/louse population.
An effective vaccine was developed by 1930 by Rudolph Weigl, but it didn't lend itself to safe mass production. His method involved harvesting the infected guts of fleas and lice, then processing the result into a vaccine. The technique was also highly dangerous to production personnel, who bore a strong risk of becoming infected with the disease. A safer method of vaccine production was badly needed.
That development came in 1938 when Herald Cox used the egg yolk incubation technique, which was much safer for production personel. The vaccine had become generally available by 1943.