(Survival manual/6. Medical/ b) Disease/Typhus)

It has been estimated that epidemic typhus has caused more deaths than all the wars in history.

Epidemic typhus is found most frequently during times of war and deprivation. (also called camp fever, jail fever, hospital fever, ship fever, famine fever, Epidemic louse-borne typhus,and louse-borne typhus) is a form of typhus so named because the disease often causes epidemics following wars and natural disasters.

Typhus was the most common waterborne disease according to Thomas Sydenham, England’s first great physician of the 17th century. A disease caused by contamination from human feces.

Epidemic Typhus is carried by the body louse and is excreted in the feces. The human scratches the bite and rubs the feces into the wound and contracts the disease, which incubates 1-2 weeks. Epidemics occurred throughout Europe from the 17th-19th century. Known as “Gaol Fever” in prisons, it was very common. Widespread epidemics occurred during the Napoleonic Wars and during the Potato Famine 1846-1849.

Throughout the middle ages and into the early part of the 20th century, periodic epidemics of typhus infection killed millions of people. As an example, during the eight-year period from 1917 to 1925, over 25 million cases of epidemic typhus occurred in Russia, causing an estimated three million deaths.

Epidemic typhus is now a rare disease, but two recent developments illustrate that an understanding of it is still important to clinicians:
•  A new cycle of infection involving flying squirrels and their ectoparasites with secondary transmission to humans has been recognized in the United States.
•  More than 45,000 cases of epidemic typhus occurred in Burundi in association with civil war during the 1990s; body louse infestation preceded outbreaks of both epidemic typhus and trench fever.

The outbreaks of typhus in Africa illustrate that the words of Hans Zinsser are still applicable today: “Typhus is not dead. It will live on for centuries and it will continue to break into the open whenever human stupidity and brutality give it a chance as most likely they occasionally will”.

The four main types of typhus are:
•  epidemic typhus (global, in areas with cold weather, poverty, war  and/or disaster)
•  Brill-Zinsser disease (a reinfection of epidemic typhus)
•  endemic or murine typhus (southeast and south USA)
•  scrub typhus (not in North America)
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 in which 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 that 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. [Its not enough to plan for food, water storage, personal protection in the eventuality of a long term disaster. Its as vitally important to protect yourself from bacteria, viral and insect infectionss. Maintain heat, warmth, relatively low density living arrangements, personal hygiene, make sure you have clean-sanitary clothing, and maintain sanitary cooking and eating utensils, only drink water that has been sanitized. Mr. Larry]

Epidemic typhus symptoms:
•  fever,
•  headache,
•  weakness, and muscle aches,
•  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.
While children usually recover well from epidemic typhus, older adults may have as much as a 60% death rate without treatment.

Brill-Zinsser disease is a reactivation of an earlier infection with epidemic typhus. It affects people years after they have 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.
•  Brill-Zinsser disease is quite mild, resulting in about a week-long fever, and a light rash similar to that of the original illness.
•  Brill-Zinsser, on the other hand, carries no threat of death.

Murine typhus occurs in the southeastern and southern United States, often during the summer and fall. It is rarely deadly. Risk factors for murine typhus include:
•  Exposure to rat fleas or rat feces
•  Exposure to other animals (such as cats, opossums, raccoons, skunks, and rats)

Symptoms of murine typhus may include:
•  Abdominal pain
•  Backache
•  Dull red rash that begins on the middle of the body and spreads
•  Extremely high fever (105 – 106 degrees Fahrenheit), which may last up to 2 weeks
•  Hacking, dry cough
•  Headache
•  Joint pain
•  Nausea
•  Vomiting
•  The early rash is a light rose color and fades when you press on it. Later, the rash becomes dull and red and does not fade. People with severe typhus may also develop small areas of bleeding into the skin

Treatment includes antibiotics such as:
•  Doxycycline
•  Tetracycline
•  Zithromax

Patients with epidemic typhus may need intravenous fluids and oxygen.

•  Clean drinking water and personal sanitation are a must.
•  Avoid areas where you might encounter rat fleas or lice.
•  Good sanitation and public health measures reduce the rat population.

Measures to get rid of lice when an infection has been found include:
•  Bathing;
•  boiling clothes or avoiding infested clothing for at least 5 days (lice will die without feeding on blood);
•  using insecticides (10% DDT, 1% malathion, or 1% permethrin)

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