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{{Typhus}} | |||
{{CMG}} ; {{AE}} {{ADG}} | |||
== Overview == | |||
'''Typhus''' a group of diseases caused by [[louse]]-borne bacteria. The name comes from the [[Greek language|Greek]] ''typhos'', meaning smoky or lazy, describing the state of mind of those affected with typhus. ''[[Rickettsia typhi|Rickettsia]]'' is endemic in rodent hosts, including mice and rats, and spreads to humans through mites, fleas and body lice. The arthropod vector flourishes under conditions of poor hygiene, such as those found in prisons or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field. In tropical countries, typhus is often mistaken for [[dengue fever]].<ref name="urlInformation for Health Care Providers">{{cite web |url=https://www.cdc.gov/typhus/healthcare-providers/index.html |title=Information for Health Care Providers |format= |work= |accessdate=}}</ref><ref name="pmid28457356">{{cite journal |vauthors=Fang R, Blanton LS, Walker DH |title=Rickettsiae as Emerging Infectious Agents |journal=Clin. Lab. Med. |volume=37 |issue=2 |pages=383–400 |year=2017 |pmid=28457356 |doi=10.1016/j.cll.2017.01.009 |url=}}</ref><ref name="pmid27983969">{{cite journal |vauthors=Tsioutis C, Zafeiri M, Avramopoulos A, Prousali E, Miligkos M, Karageorgos SA |title=Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review |journal=Acta Trop. |volume=166 |issue= |pages=16–24 |year=2017 |pmid=27983969 |doi=10.1016/j.actatropica.2016.10.018 |url=}}</ref><ref name="pmid26261776">{{cite journal |vauthors=Peter JV, Sudarsan TI, Prakash JA, Varghese GM |title=Severe scrub typhus infection: Clinical features, diagnostic challenges and management |journal=World J Crit Care Med |volume=4 |issue=3 |pages=244–50 |year=2015 |pmid=26261776 |pmc=4524821 |doi=10.5492/wjccm.v4.i3.244 |url=}}</ref><ref name="urlEpidemic Typhus">{{cite web |url=https://www.cdc.gov/typhus/epidemic/index.html |title=Epidemic Typhus |format= |work= |accessdate=}}</ref> | |||
==Historical Perspective== | |||
The first description of typhus was given in 1083 at a convent near Salerno, Italy. In 1546, Girolamo Fracastoro, a Florentine physician, described [[typhus]] in his famous treatise on viruses and contagion, De Contagione et Contagiosis Morbis. Before a [[vaccine]] was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of epidemics throughout history. These [[epidemics]] tend to follow wars, famine, and other conditions that result in mass casualties. The first reliable description of the disease appears during the Spanish siege of Moorish Granada in 1489. These accounts include descriptions of [[fever]] and [[Rash|red spots]] over arms, back and chest, progressing to [[delirium]], [[Gangrenous|gangrenous sores]], and the stink of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action but an additional 17,000 died of typhus. Typhus was also common in prisons (and in crowded conditions where lice spread easily), where it was known as Gaol fever or Jail fever. Gaol fever often occurs when prisoners are frequently huddled together in dark, filthy rooms. Imprisonment until the next term of court was often equivalent to a death sentence. It was so infectious that prisoners brought before the court sometimes infected the court itself. Following the Assize held at Oxford in 1577, later deemed the Black Assize, over 300 died from Epidemic typhus, including Sir Robert Bell Lord Chief Baron of the Exchequer. The outbreak that followed, between 1557 to 1559, killed about 10% of the English population.<ref name="urlMAINTENANCE OF HUMAN-FED LIVE LICE IN THE LABORATORY AND PRODUCTION OF WEIGLS EXANTHEMATOUS TYPHUS VACCINE">{{cite web |url=http://www.lwow.home.pl/Weigl.html |title=MAINTENANCE OF HUMAN-FED LIVE LICE IN THE LABORATORY AND PRODUCTION OF WEIGL'S EXANTHEMATOUS TYPHUS VACCINE |format= |work= |accessdate=}}</ref> | |||
{{Typhus}} | ==Classification== | ||
Typhus is a group of diseases caused by [[bacteria]] that are spread to humans by fleas, lice, and chiggers. Typhus fevers include scrub typhus, murine typhus, and epidemic typhus. Chiggers spread scrub typhus, fleas spread murine typhus, and body lice spread epidemic typhus. The most common symptoms are [[Fever|fever,]] [[headaches]], and sometimes [[rash]].<ref name="urlTyphus Fevers">{{cite web |url=https://www.cdc.gov/typhus/index.html |title=Typhus Fevers |format= |work= |accessdate=}}</ref> | |||
{{ | ==Pathophysiology== | ||
Typhus is a [[Zoonotic|zoonotic disease]], humans are infected by the bites from parasites such as fleas, lice, mites, and ticks or by the inoculation of infectious fluids or feces from the parasites into the [[skin]]. The incubation period of Typhus fever varies from one to two weeks. Following transmission, [[Rickettsia typhi|rickettsia]] are ingested by [[macrophages]] and [[polymorphonuclear cells]]. The major pathology is caused by a [[vasculitis]] and its complications. This process may cause result in occlusion of blood vessels and initiates an [[inflammatory response]] (aggregation of [[leukocytes]], [[macrophages]], and [[platelets]]) resulting in small nodules. This vasculitic process causes destruction of the [[endothelial cells]] and leakage of the blood leading to volume depletion with subsequent [[hypovolemia]] and decreased tissue perfusion and, possibly, [[Organ failure|organ failure.]]<ref name="pmid22449515">{{cite journal |vauthors=Rajapakse S, Rodrigo C, Fernando D |title=Scrub typhus: pathophysiology, clinical manifestations and prognosis |journal=Asian Pac J Trop Med |volume=5 |issue=4 |pages=261–4 |year=2012 |pmid=22449515 |doi=10.1016/S1995-7645(12)60036-4 |url=}}</ref><ref name="pmid12860594">{{cite journal |vauthors=Walker DH, Valbuena GA, Olano JP |title=Pathogenic mechanisms of diseases caused by Rickettsia |journal=Ann. N. Y. Acad. Sci. |volume=990 |issue= |pages=1–11 |year=2003 |pmid=12860594 |doi= |url=}}</ref><ref name="pmid18366341">{{cite journal |vauthors=Bechah Y, Capo C, Mege JL, Raoult D |title=Rickettsial diseases: from Rickettsia-arthropod relationships to pathophysiology and animal models |journal=Future Microbiol |volume=3 |issue=2 |pages=223–36 |year=2008 |pmid=18366341 |doi=10.2217/17460913.3.2.223 |url=}}</ref><ref name="pmid19327117">{{cite journal |vauthors=Sahni SK, Rydkina E |title=Host-cell interactions with pathogenic Rickettsia species |journal=Future Microbiol |volume=4 |issue=3 |pages=323–39 |year=2009 |pmid=19327117 |pmc=2775711 |doi=10.2217/fmb.09.6 |url=}}</ref><ref name="pmid24059918">{{cite journal |vauthors=Sahni SK, Narra HP, Sahni A, Walker DH |title=Recent molecular insights into rickettsial pathogenesis and immunity |journal=Future Microbiol |volume=8 |issue=10 |pages=1265–88 |year=2013 |pmid=24059918 |pmc=3923375 |doi=10.2217/fmb.13.102 |url=}}</ref> | |||
== | ==Causes== | ||
[[Typhus]] is caused by one of two types of [[bacteria]] ''Rickettsia typhi'' or ''Rickettsia prowazekii''. The form of typhus depends on which type of bacteria causes the infection. ''Rickettsia typhi'' causes murine or endemic typhus. Endemic typhus is uncommon in the United States. It is usually seen in areas where hygiene is poor and the temperature is cold. Endemic typhus is sometimes called "jail fever." Murine typhus occurs in the southeastern and southern United States.<ref name="urlInformation for Health Care Providers">{{cite web |url=https://www.cdc.gov/typhus/healthcare-providers/index.html |title=Information for Health Care Providers |format= |work= |accessdate=}}</ref><ref name="urlRickettsial (Spotted & Typhus Fevers) & Related Infections (Anaplasmosis & Ehrlichiosis) - Chapter 3 - 2016 Yellow Book | Travelers Health | CDC">{{cite web |url=https://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/rickettsial-spotted-typhus-fevers-related-infections-anaplasmosis-ehrlichiosis |title=Rickettsial (Spotted & Typhus Fevers) & Related Infections (Anaplasmosis & Ehrlichiosis) - Chapter 3 - 2016 Yellow Book | Travelers' Health | CDC |format= |work= |accessdate=}}</ref> | |||
==Differentiating Typhus from other Diseases== | |||
Typhus must be differentiated from other diseases that cause [[fever]], [[rash]], [[diarrhea]] and [[Nausea and vomiting|vomiting]], such as [[Ebola]], [[Typhoid fever]], [[Malaria]] and [[Lassa fever]].<ref name="pmid28457350">{{cite journal |vauthors=Brown CS, Mepham S, Shorten RJ |title=Ebola Virus Disease: An Update on Epidemiology, Symptoms, Laboratory Findings, Diagnostic Issues, and Infection Prevention and Control Issues for Laboratory Professionals |journal=Clin. Lab. Med. |volume=37 |issue=2 |pages=269–284 |year=2017 |pmid=28457350 |doi=10.1016/j.cll.2017.01.003 |url=}}</ref><ref name="pmid28398679">{{cite journal |vauthors=Bebell LM, Oduyebo T, Riley LE |title=Ebola virus disease and pregnancy: A review of the current knowledge of Ebola virus pathogenesis, maternal, and neonatal outcomes |journal=Birth Defects Res |volume=109 |issue=5 |pages=353–362 |year=2017 |pmid=28398679 |doi=10.1002/bdra.23558 |url=}}</ref><ref name="pmid27193549">{{cite journal |vauthors=Spanò S |title=Mechanisms of Salmonella Typhi Host Restriction |journal=Adv. Exp. Med. Biol. |volume=915 |issue= |pages=283–94 |year=2016 |pmid=27193549 |doi=10.1007/978-3-319-32189-9_17 |url=}}</ref><ref name="pmid28357581">{{cite journal |vauthors=Basu S, Sahi PK |title=Malaria: An Update |journal=Indian J Pediatr |volume= |issue= |pages= |year=2017 |pmid=28357581 |doi=10.1007/s12098-017-2332-2 |url=}}</ref><ref name="pmid28265442">{{cite journal |vauthors=Brosh-Nissimov T |title=Lassa fever: another threat from West Africa |journal=Disaster Mil Med |volume=2 |issue= |pages=8 |year=2016 |pmid=28265442 |pmc=5330145 |doi=10.1186/s40696-016-0018-3 |url=}}</ref> | |||
==Epidemiology and Demographics== | |||
The Centers for Disease Control and Prevention have documented only 47 cases from 1976 to 2010. According to the World Health Organization, the case fatality rate from typhus is about 1 out of every 5,000,000 people per year. All age groups are at risk for rickettsial infections during travel to endemic areas. The typhus group of infections has no sexual predilection. Scrub typhus, which is transmitted by mites encountered in high grass and brush, is endemic in northern Japan, Southeast Asia, the western Pacific Islands, eastern Australia, China, maritime areas and several parts of south-central Russia, India, and Sri Lanka. R. typhi and R. felis, which are transmitted by fleas, are widely distributed, especially throughout the tropics and subtropics and in port cities and coastal regions with rodents.<ref name="urlRickettsial (Spotted & Typhus Fevers) & Related Infections (Anaplasmosis & Ehrlichiosis) - Chapter 3 - 2016 Yellow Book | Travelers Health | CDC">{{cite web |url=https://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/rickettsial-spotted-typhus-fevers-related-infections-anaplasmosis-ehrlichiosis |title=Rickettsial (Spotted & Typhus Fevers) & Related Infections (Anaplasmosis & Ehrlichiosis) - Chapter 3 - 2016 Yellow Book | Travelers' Health | CDC |format= |work= |accessdate=}}</ref><ref name="urlEpidemic Typhus">{{cite web |url=https://www.cdc.gov/typhus/epidemic/index.html |title=Epidemic Typhus |format= |work= |accessdate=}}</ref | |||
== Risk Factors == | == Risk Factors == | ||
Travelers may be at risk for exposure to agents of rickettsial diseases if they engage in occupational or recreational activities which bring them into contact with habitats that support the vectors or animal reservoir species associated with these pathogens. [[Immunocompromised host|Immunocompromised patients]] are at risk. | |||
==Natural history, Complications, and Prognosis== | |||
Rickettsioses range in severity from diseases that are usually relatively mild ([[rickettsialpox]], [[cat scratch disease]], and African tick-bite fever) to those that can be life-threatening ([[Epidemic typhus|epidemic]] and [[murine typhus]], [[Rocky Mountain spotted fever]], [[scrub typhus]] and Oroya fever), and they vary in duration from those that can be self-limiting to chronic ([[Q fever]] and bartonelloses) or recrudescent (Brill-Zinsser disease). Without treatment, [[fever]] may last 2 weeks, followed by a prolonged recovery time and a significantly greater chance of developing neurological complications. Possible complications include renal insufficiency, [[pneumonia]], [[meningitis]]. Without treatment, death may occur in 10 - 60% of patients with [[epidemic typhus]]. Patients over age 60 have the highest risk of death.<ref name="pmid27983969">{{cite journal |vauthors=Tsioutis C, Zafeiri M, Avramopoulos A, Prousali E, Miligkos M, Karageorgos SA |title=Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review |journal=Acta Trop. |volume=166 |issue= |pages=16–24 |year=2017 |pmid=27983969 |doi=10.1016/j.actatropica.2016.10.018 |url=}}</ref><ref name="pmid26937940">{{cite journal |vauthors=Zhou YH, Xia FQ, Van Poucke S, Zheng MH |title=Successful Treatment of Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis With Chloramphenicol: Report of 3 Pediatric Cases and Literature Review |journal=Medicine (Baltimore) |volume=95 |issue=8 |pages=e2928 |year=2016 |pmid=26937940 |pmc=4779037 |doi=10.1097/MD.0000000000002928 |url=}}</ref><ref name="pmid26274584">{{cite journal |vauthors=Taylor AJ, Paris DH, Newton PN |title=A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi) |journal=PLoS Negl Trop Dis |volume=9 |issue=8 |pages=e0003971 |year=2015 |pmid=26274584 |pmc=4537241 |doi=10.1371/journal.pntd.0003971 |url=}}</ref><ref name="pmid25262433">{{cite journal |vauthors=Delord M, Socolovschi C, Parola P |title=Rickettsioses and Q fever in travelers (2004-2013) |journal=Travel Med Infect Dis |volume=12 |issue=5 |pages=443–58 |year=2014 |pmid=25262433 |doi=10.1016/j.tmaid.2014.08.006 |url=}}</ref><ref name="pmid25062435">{{cite journal |vauthors=van der Vaart TW, van Thiel PP, Juffermans NP, van Vugt M, Geerlings SE, Grobusch MP, Goorhuis A |title=Severe murine typhus with pulmonary system involvement |journal=Emerging Infect. Dis. |volume=20 |issue=8 |pages=1375–7 |year=2014 |pmid=25062435 |pmc=4111165 |doi=10.3201/eid2008.131421 |url=}}</ref><ref name="pmid25102120">{{cite journal |vauthors=Dotters-Katz SK, Kuller J, Heine RP |title=Arthropod-borne bacterial diseases in pregnancy |journal=Obstet Gynecol Surv |volume=68 |issue=9 |pages=635–49 |year=2013 |pmid=25102120 |doi=10.1097/OGX.0b013e3182a5ed46 |url=}}</ref> | |||
==Diagnosis== | |||
===History and Symptoms=== | |||
Signs and symptoms of typhus usually appear abruptly, 8–16 days following exposure to infected lice. Illness can vary from mild to severe, and even life-threatening. Symptoms of acute infection are generally non-specific and include [[fever]] and chills, [[headache]], [[Tachypnea|rapid breathing]], [[myalgia]], [[rash]], [[cough]], [[Nausea and vomiting|nausea, vomiting]] and [[altered mental status]].<ref name="urlInformation for Health Care Providers">{{cite web |url=https://www.cdc.gov/typhus/healthcare-providers/index.html |title=Information for Health Care Providers |format= |work= |accessdate=}}</ref><ref name="urlEpidemic Typhus">{{cite web |url=https://www.cdc.gov/typhus/epidemic/index.html |title=Epidemic Typhus |format= |work= |accessdate=}}</ref><ref name="urlMurine Typhus">{{cite web |url=https://www.cdc.gov/typhus/murine/index.html |title=Murine Typhus |format= |work= |accessdate=}}</ref><ref name="urlScrub Typhus">{{cite web |url=https://www.cdc.gov/typhus/scrub/index.html |title=Scrub Typhus |format= |work= |accessdate=}}</ref> | |||
===Physical examination=== | |||
Typhus presents with high-grade fever and a [[maculopapular rash]]. [[Generalized lymphadenopathy]] is present in majority of the patients. Physical examination usually reveals a combination of several non-specific findings.<ref name="urlEpidemic Typhus">{{cite web |url=https://www.cdc.gov/typhus/epidemic/index.html |title=Epidemic Typhus |format= |work= |accessdate=}}</ref><ref name="urlMurine Typhus">{{cite web |url=https://www.cdc.gov/typhus/murine/index.html |title=Murine Typhus |format= |work= |accessdate=}}</ref><ref name="urlScrub Typhus">{{cite web |url=https://www.cdc.gov/typhus/scrub/index.html |title=Scrub Typhus |format= |work= |accessdate=}}</ref> | |||
===Laboratory findings=== | |||
Diagnosis of typhus is usually based on clinical recognition and serology, the latter requires comparison of acute- to convalescent-phase serology, so is only helpful in retrospect. Etiologic agents can generally only be identified to the genus level by serologic testing. [[PCR]] and immunohistochemical analyses may also be helpful.<ref name="pmid17205447">{{cite journal |vauthors=Blacksell SD, Bryant NJ, Paris DH, Doust JA, Sakoda Y, Day NP |title=Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to a lot of confusion |journal=Clin. Infect. Dis. |volume=44 |issue=3 |pages=391–401 |year=2007 |pmid=17205447 |doi=10.1086/510585 |url=}}</ref><ref name="pmid10853230">{{cite journal |vauthors=Kovácová E, Kazár J |title=Rickettsial diseases and their serological diagnosis |journal=Clin. Lab. |volume=46 |issue=5-6 |pages=239–45 |year=2000 |pmid=10853230 |doi= |url=}}</ref><ref name="pmid2678763">{{cite journal |vauthors=Chong Y |title=Application of serologic diagnosis of tsutsugamushi disease (scrub typhus) in Korea where the disease was recently recognized to be endemic |journal=Yonsei Med. J. |volume=30 |issue=2 |pages=111–7 |year=1989 |pmid=2678763 |doi=10.3349/ymj.1989.30.2.111 |url=}}</ref> | |||
===Other diagnostic studies=== | |||
There is no specific X-ray, CT or MRI finding associated with [[typhus]]. | |||
== Treatment == | == Treatment == | ||
=== Medical Therapy === | === Medical Therapy === | ||
Treatments for most rickettsial illnesses are similar and include administration of appropriate antibiotics (e.g., [[tetracycline]]s, [[chloramphenicol]], [[azithromycin]], [[fluoroquinolone]]s, and [[rifampin]]) and supportive care. Treatment should usually be given empirically prior to disease confirmation, and the particular antimicrobial agent and the length of treatment are dependent upon the disease and the host.<ref name="urlInformation for Health Care Providers">{{cite web |url=https://www.cdc.gov/typhus/healthcare-providers/index.html |title=Information for Health Care Providers |format= |work= |accessdate=}}</ref> | |||
===Surgery=== | |||
Surgical intervention is not recommended for the management of typhus. | |||
=== Primary Prevention === | === Primary Prevention === | ||
No licensed vaccines for prevention of rickettsial infections are commercially available in the United States. With the exception of the louse-borne diseases, for which contact with infectious arthropod feces is the primary mode of transmission (through autoinoculation into a wound, conjunctiva, or inhalation), travelers and health-care providers are generally not at risk for becoming infected via exposure to an ill person. Limiting exposures to vectors or animal reservoirs remains the best means for reducing the risk for disease. Travelers should be advised that prevention is based on avoidance of vector-infested habitats, use of repellents and protective clothing, prompt detection and removal of arthropods from clothing and skin, and attention to hygiene | No licensed vaccines for prevention of rickettsial infections are commercially available in the United States. With the exception of the louse-borne diseases, for which contact with infectious arthropod feces is the primary mode of transmission (through autoinoculation into a wound, conjunctiva, or inhalation), travelers and health-care providers are generally not at risk for becoming infected via exposure to an ill person. Limiting exposures to vectors or animal reservoirs remains the best means for reducing the risk for disease. Travelers should be advised that prevention is based on avoidance of vector-infested habitats, use of repellents and protective clothing, prompt detection and removal of arthropods from clothing and skin, and attention to hygiene.<ref name="urlInformation for Health Care Providers">{{cite web |url=https://www.cdc.gov/typhus/healthcare-providers/index.html |title=Information for Health Care Providers |format= |work= |accessdate=}}</ref> | ||
== References == | == References == | ||
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[[Category:Biological weapons]] | [[Category:Biological weapons]] | ||
[[Category:Rickettsiales]] | [[Category:Rickettsiales]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Gastroenterology]] | |||
[[Category:Pulmonology]] |
Latest revision as of 00:32, 30 July 2020
Typhus Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Typhus overview On the Web |
American Roentgen Ray Society Images of Typhus overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Typhus a group of diseases caused by louse-borne bacteria. The name comes from the Greek typhos, meaning smoky or lazy, describing the state of mind of those affected with typhus. Rickettsia is endemic in rodent hosts, including mice and rats, and spreads to humans through mites, fleas and body lice. The arthropod vector flourishes under conditions of poor hygiene, such as those found in prisons or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field. In tropical countries, typhus is often mistaken for dengue fever.[1][2][3][4][5]
Historical Perspective
The first description of typhus was given in 1083 at a convent near Salerno, Italy. In 1546, Girolamo Fracastoro, a Florentine physician, described typhus in his famous treatise on viruses and contagion, De Contagione et Contagiosis Morbis. Before a vaccine was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of epidemics throughout history. These epidemics tend to follow wars, famine, and other conditions that result in mass casualties. The first reliable description of the disease appears during the Spanish siege of Moorish Granada in 1489. These accounts include descriptions of fever and red spots over arms, back and chest, progressing to delirium, gangrenous sores, and the stink of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action but an additional 17,000 died of typhus. Typhus was also common in prisons (and in crowded conditions where lice spread easily), where it was known as Gaol fever or Jail fever. Gaol fever often occurs when prisoners are frequently huddled together in dark, filthy rooms. Imprisonment until the next term of court was often equivalent to a death sentence. It was so infectious that prisoners brought before the court sometimes infected the court itself. Following the Assize held at Oxford in 1577, later deemed the Black Assize, over 300 died from Epidemic typhus, including Sir Robert Bell Lord Chief Baron of the Exchequer. The outbreak that followed, between 1557 to 1559, killed about 10% of the English population.[6]
Classification
Typhus is a group of diseases caused by bacteria that are spread to humans by fleas, lice, and chiggers. Typhus fevers include scrub typhus, murine typhus, and epidemic typhus. Chiggers spread scrub typhus, fleas spread murine typhus, and body lice spread epidemic typhus. The most common symptoms are fever, headaches, and sometimes rash.[7]
Pathophysiology
Typhus is a zoonotic disease, humans are infected by the bites from parasites such as fleas, lice, mites, and ticks or by the inoculation of infectious fluids or feces from the parasites into the skin. The incubation period of Typhus fever varies from one to two weeks. Following transmission, rickettsia are ingested by macrophages and polymorphonuclear cells. The major pathology is caused by a vasculitis and its complications. This process may cause result in occlusion of blood vessels and initiates an inflammatory response (aggregation of leukocytes, macrophages, and platelets) resulting in small nodules. This vasculitic process causes destruction of the endothelial cells and leakage of the blood leading to volume depletion with subsequent hypovolemia and decreased tissue perfusion and, possibly, organ failure.[8][9][10][11][12]
Causes
Typhus is caused by one of two types of bacteria Rickettsia typhi or Rickettsia prowazekii. The form of typhus depends on which type of bacteria causes the infection. Rickettsia typhi causes murine or endemic typhus. Endemic typhus is uncommon in the United States. It is usually seen in areas where hygiene is poor and the temperature is cold. Endemic typhus is sometimes called "jail fever." Murine typhus occurs in the southeastern and southern United States.[1][13]
Differentiating Typhus from other Diseases
Typhus must be differentiated from other diseases that cause fever, rash, diarrhea and vomiting, such as Ebola, Typhoid fever, Malaria and Lassa fever.[14][15][16][17][18]
Epidemiology and Demographics
The Centers for Disease Control and Prevention have documented only 47 cases from 1976 to 2010. According to the World Health Organization, the case fatality rate from typhus is about 1 out of every 5,000,000 people per year. All age groups are at risk for rickettsial infections during travel to endemic areas. The typhus group of infections has no sexual predilection. Scrub typhus, which is transmitted by mites encountered in high grass and brush, is endemic in northern Japan, Southeast Asia, the western Pacific Islands, eastern Australia, China, maritime areas and several parts of south-central Russia, India, and Sri Lanka. R. typhi and R. felis, which are transmitted by fleas, are widely distributed, especially throughout the tropics and subtropics and in port cities and coastal regions with rodents.[13][19][20][21][22][23]
Diagnosis
History and Symptoms
Signs and symptoms of typhus usually appear abruptly, 8–16 days following exposure to infected lice. Illness can vary from mild to severe, and even life-threatening. Symptoms of acute infection are generally non-specific and include fever and chills, headache, rapid breathing, myalgia, rash, cough, nausea, vomiting and altered mental status.[1][5][24][25]
Physical examination
Typhus presents with high-grade fever and a maculopapular rash. Generalized lymphadenopathy is present in majority of the patients. Physical examination usually reveals a combination of several non-specific findings.[5][24][25]
Laboratory findings
Diagnosis of typhus is usually based on clinical recognition and serology, the latter requires comparison of acute- to convalescent-phase serology, so is only helpful in retrospect. Etiologic agents can generally only be identified to the genus level by serologic testing. PCR and immunohistochemical analyses may also be helpful.[26][27][28]
Other diagnostic studies
There is no specific X-ray, CT or MRI finding associated with typhus.
Treatment
Medical Therapy
Treatments for most rickettsial illnesses are similar and include administration of appropriate antibiotics (e.g., tetracyclines, chloramphenicol, azithromycin, fluoroquinolones, and rifampin) and supportive care. Treatment should usually be given empirically prior to disease confirmation, and the particular antimicrobial agent and the length of treatment are dependent upon the disease and the host.[1]
Surgery
Surgical intervention is not recommended for the management of typhus.
Primary Prevention
No licensed vaccines for prevention of rickettsial infections are commercially available in the United States. With the exception of the louse-borne diseases, for which contact with infectious arthropod feces is the primary mode of transmission (through autoinoculation into a wound, conjunctiva, or inhalation), travelers and health-care providers are generally not at risk for becoming infected via exposure to an ill person. Limiting exposures to vectors or animal reservoirs remains the best means for reducing the risk for disease. Travelers should be advised that prevention is based on avoidance of vector-infested habitats, use of repellents and protective clothing, prompt detection and removal of arthropods from clothing and skin, and attention to hygiene.[1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 "Information for Health Care Providers".
- ↑ Fang R, Blanton LS, Walker DH (2017). "Rickettsiae as Emerging Infectious Agents". Clin. Lab. Med. 37 (2): 383–400. doi:10.1016/j.cll.2017.01.009. PMID 28457356.
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- ↑ 5.0 5.1 5.2 "Epidemic Typhus".
- ↑ "MAINTENANCE OF HUMAN-FED LIVE LICE IN THE LABORATORY AND PRODUCTION OF WEIGL'S EXANTHEMATOUS TYPHUS VACCINE".
- ↑ "Typhus Fevers".
- ↑ Rajapakse S, Rodrigo C, Fernando D (2012). "Scrub typhus: pathophysiology, clinical manifestations and prognosis". Asian Pac J Trop Med. 5 (4): 261–4. doi:10.1016/S1995-7645(12)60036-4. PMID 22449515.
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- ↑ 13.0 13.1 "Rickettsial (Spotted & Typhus Fevers) & Related Infections (Anaplasmosis & Ehrlichiosis) - Chapter 3 - 2016 Yellow Book | Travelers' Health | CDC".
- ↑ Brown CS, Mepham S, Shorten RJ (2017). "Ebola Virus Disease: An Update on Epidemiology, Symptoms, Laboratory Findings, Diagnostic Issues, and Infection Prevention and Control Issues for Laboratory Professionals". Clin. Lab. Med. 37 (2): 269–284. doi:10.1016/j.cll.2017.01.003. PMID 28457350.
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- ↑ Spanò S (2016). "Mechanisms of Salmonella Typhi Host Restriction". Adv. Exp. Med. Biol. 915: 283–94. doi:10.1007/978-3-319-32189-9_17. PMID 27193549.
- ↑ Basu S, Sahi PK (2017). "Malaria: An Update". Indian J Pediatr. doi:10.1007/s12098-017-2332-2. PMID 28357581.
- ↑ Brosh-Nissimov T (2016). "Lassa fever: another threat from West Africa". Disaster Mil Med. 2: 8. doi:10.1186/s40696-016-0018-3. PMC 5330145. PMID 28265442.
- ↑ Zhou YH, Xia FQ, Van Poucke S, Zheng MH (2016). "Successful Treatment of Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis With Chloramphenicol: Report of 3 Pediatric Cases and Literature Review". Medicine (Baltimore). 95 (8): e2928. doi:10.1097/MD.0000000000002928. PMC 4779037. PMID 26937940.
- ↑ Taylor AJ, Paris DH, Newton PN (2015). "A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi)". PLoS Negl Trop Dis. 9 (8): e0003971. doi:10.1371/journal.pntd.0003971. PMC 4537241. PMID 26274584.
- ↑ Delord M, Socolovschi C, Parola P (2014). "Rickettsioses and Q fever in travelers (2004-2013)". Travel Med Infect Dis. 12 (5): 443–58. doi:10.1016/j.tmaid.2014.08.006. PMID 25262433.
- ↑ van der Vaart TW, van Thiel PP, Juffermans NP, van Vugt M, Geerlings SE, Grobusch MP, Goorhuis A (2014). "Severe murine typhus with pulmonary system involvement". Emerging Infect. Dis. 20 (8): 1375–7. doi:10.3201/eid2008.131421. PMC 4111165. PMID 25062435.
- ↑ Dotters-Katz SK, Kuller J, Heine RP (2013). "Arthropod-borne bacterial diseases in pregnancy". Obstet Gynecol Surv. 68 (9): 635–49. doi:10.1097/OGX.0b013e3182a5ed46. PMID 25102120.
- ↑ 24.0 24.1 "Murine Typhus".
- ↑ 25.0 25.1 "Scrub Typhus".
- ↑ Blacksell SD, Bryant NJ, Paris DH, Doust JA, Sakoda Y, Day NP (2007). "Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to a lot of confusion". Clin. Infect. Dis. 44 (3): 391–401. doi:10.1086/510585. PMID 17205447.
- ↑ Kovácová E, Kazár J (2000). "Rickettsial diseases and their serological diagnosis". Clin. Lab. 46 (5–6): 239–45. PMID 10853230.
- ↑ Chong Y (1989). "Application of serologic diagnosis of tsutsugamushi disease (scrub typhus) in Korea where the disease was recently recognized to be endemic". Yonsei Med. J. 30 (2): 111–7. doi:10.3349/ymj.1989.30.2.111. PMID 2678763.