Typhus then and now
Typhus is a rickettsial (particle like bacteria) illness transmitted to people by a variety of biting insects. Historically it caused devastating plague like epidemics and can still be encountered rarely by the modern traveler.
Different biting insects are associated with different disease patterns.
Epidemic Louse-Borne Typhus occurs in Africa, Central and South America, Asia, Eastern Europe, and Mexico. Epidemics occur in poverty and war stricken areas. These rickettsia are transmitted by body lice, which live in clothing and feed on blood. Their feces enter wounds or is inhaled. This disease is not transmitted person to person.
Symptoms of epidemic louse-borne typhus include: high fever, headache, dry cough, muscle pain, and nausea with vomiting. All symptoms occur within 2 weeks of being bitten. Afterwards a rash appears on the torso and then spreads to the rest of the body (the rash of Rocky Mountain Spotted Fever starts in the extremities first). This disease can cause multiple organ disease and death.
Epidemic Flea-Borne Typhus occurs worldwide and is common in ports and central areas. The disease is carried by rats and transmitted to people by flea bites (in the U.S the disease is found in dogs, cats, and opossums).
Symptoms occur gradually over 2 weeks and are similar though milder than epidemic typhus (see above).
Full recovery is usual even without treatment and fatalities are rare.
Typhus was very much feared by armies as a disease with a high fatality rate possibly more dangerous than an enemy combat engagement!
It was very much a danger in Nazi concentration camps such as Camp Bergen-Benson where Anne Frank and her sister Margot died of typhus in 1945.
Two very clever Polish physicians Dr Lazowski and Dr Watulewicz came up with an ingenious plan to protect Poles from being deported to Concentration camps during WW2.
They had realized that the Welix-Felix test- a blood test for typhus also cross-reacted with another bacterium Proteus OX19 that is actually harmless.
So they actually cultivated Proteus OX19 and infected large amounts of people with these harmless bacteria that cause no human disease but made the recipients appear highly contagious.
The Axis leaders so much feared a large typhus outbreak spreading to the army that those Proteus infected villages were quarantined and no one from these places was deported saving an estimated 8000 lives from a certain death.
Today’s travelers are more likely to encounter Tick typhus, as the louse and flea are more associated with refugee situations.
Tick Typhus is transmitted to humans by ticks in parts of Africa. Infective ticks infest domestic and wild animals particularly dogs in cities.
Walking in brush is risky. A black scab like scar (eschar) develops at the bite site and the rickettsia incubates for about 1 week .A fever develops with a rash (which may be very small).
This rash and eschar are very typical of tick typhus but often this illness is confused with malaria or a traveler's diarrhea infection.
A headache is also noted. Usually symptoms are mild but kidney, liver and neurological damage can occur. Doxycycline is an effective treatment and doxycycline when given daily for the prevention of malaria may also prevent typhus.
A doctor on return should review any unusual insect bites from vacation.