Overview
Epidemic typhus is due to a bacterium called rickettsia and transmitted by the human body louse which lives on clothes and is found in places with poor sanitary conditions such as jails; hence, the disease is sometimes called “jail fever.” According to a July 2008 article on infectious disease published in the journal Lancet, Dr. Yassina Bechah states epidemic typhus remains an important public health problem, in spite of antibiotics.
Prevalence
Epidemic typhus is a disease of poverty, cold climates, disasters and war. The disease is prevalent in Africa, South America and Asia. In the U.S., there are sporadic cases of epidemic typhus transmitted by flying-squirrel fleas.
Transmission and Symptoms
The louse acquires the organism by drinking blood from a patient infected with rickettsiae. Then the louse bites another host and defecates the organism onto the skin. Since the louse cannot penetrate the skin, the patient unwittingly infects himself by scratching. After an incubation period of seven to 14 days, a pink rash appears in the arm pits, which spreads to the body and later arms and legs. The face, palms and soles are usually spared. Symptoms may include nausea, vomiting, abdominal pain, confusion, prolonged high fever of up to 104F, chills, headache that doesn’t go away, fear of going out into sunlight, or photophobia, and enlargement of the spleen.
Diagnosis
Diagnosing typhus can be difficult, but rapid treatment with appropriate antibiotic therapy is critical for rapid recovery. The diagnosis is based on the history and physical examination showing the characteristic rash. According to the U.S. Centers for Disease Control and Prevention (CDC), there are three diagnostic tests that should be performed.
The PCR, or polymerase chain reaction test, examines genetic material and is the most sensitive method of diagnosis.
Detection of rickettsiae can also be made by specific immunofluorescent tests and isolation of a rickettsial agent by culture.
The diagnosis can be confirmed by serological assays, as well, which detect a rise in antibodies to rickettsia and are the simplest to perform.
Treatment and Prognosis
Treatment for typhus is with doxycycline 200mg orally as a single dose, or until the patient has no fever for 24 hours. With antibiotic treatment, the prognosis is excellent. Without treatment, 10 to 60 percent of patients may die from epidemic typhus. Patients older than 60 years are at the highest risk of death.
Prevention/Solution
Since transmission is by person to person, prevention of epidemic typhus includes bathing, boiling clothes or avoiding infested clothing for at least five days so lice will die from lack of a blood meal. The use of insecticides should be undertaken as well, with 10 percent DDT, 1 percent malathion, or 1 percent permethrin being most effective.
About this Author
Based in New Jersey, John Riefler III has been writing since 1987. His articles have appeared in “MD Magazine,” “Emergency Medicine” and “Hospital Practice.” Riefler holds a Bachelor of Science in biology from Bucknell University, a Master of Science in microbiology from M.U.S.C. and an M.D. from St. George’s U. School of Medicine.
