Typhus (exanthematic): what it is, causes and symptoms. Is there a cure?

What is typhus?

Typhus is the name given to infectious diseases caused by bacteria in the Rickettsiaceae family . They are transmitted by parasites such as ticks, mites and lice , through the bite, or through the contact of feces with wounds in the human body.

Parasites transmit the disease when they come into contact with animals contaminated by the bacteria, such as cats, dogs, skunks, raccoons, mice, among others.

Today, this disease is much rarer. There was a major epidemic before the start of World War II, but now it is more controlled due to effective treatment and the elimination of vectors (parasites).

However, typhus has been able to cause many epidemics and deaths, especially in wars and prisons.

Hygiene and basic sanitation conditions in countries are factors that influence the emergence of cases of the disease. There is epidemic, endemic typhus and bush typhus.

A well-known case is that of Anne Frank, a teenage victim of the holocaust. His life was recorded in books, in the cinema and his diary is always among the classic books. There are records that the cause of his death and that of his sister was the epidemic typhus in February 1945.

The name typhus (typhus) is of Greek origin and means “stupor”, one of the symptoms of the disease. It was Hippocrates, considered the father of medicine, who observed this state of infected patients and, therefore, described the disease with this name.

Despite the small similarity between the names, typhus has nothing to do with typhoid fever, a disease caused by the bacterium  Salmonella enterica typhi and transmitted by the contamination of water and food.

Major epidemics caused by typhus

Typhus is a disease that has been present in some historical moments. The pathology caused major epidemics and many deaths, affecting armies at war and prisoners.

Before and even during World War II, it was one of the strongest epidemics due to the terrible conditions in which armies operated and the concentration camps, where those persecuted by the war were kept in prison. The scenario, which was already terrifying, was made worse by the disease.

Some historians say that there was already a certain knowledge of the causes and preventions of the disease, and believe that the Nazis kept the prisoners in concentration camps under the conditions that the disease happens so that they died there. Among the victims of this sad episode in history, Anne Frank was one of them.

So was Napoleon Bonaparte and his army. This moment became known in history books as the Russian Campaign. We can also say that it was at that moment that the French literally went cold. They faced, in addition to the epidemic caused by typhus, a paralyzing cold.

The soldiers, in 1812, had neither the preparation nor the strategies to combat, in addition to enemy troops, climatic obstacles and infectious diseases. Due to these circumstances, French troops were reduced from 600 thousand to 40 thousand soldiers.

Military tactics have evolved a lot from that time to the present. Much is due to this history and to the experience lived by the French. Shaving the beard and the closest haircuts are some of the reflections of these first changes. The aim was to reduce the chances of infection by eradicating the transmitting lice.

Before these epidemic episodes of typhus, the cleaning of clothes and hygiene was not very common in the daily life of the army.

There is another record of a major typhus outbreak in history, which left thousands of victims. This happened in Ireland, between 1846 and 1849, at a time in history that became known as the potato famine .

A fungus attacked the potato fields in the country and this pest was responsible for causing one of the biggest hunger outbreaks in Europe. Thousands of people died of hunger or were forced to leave the country, which until now is sad enough.

However, with the outbreak of the disease, it got even worse. The country’s population is believed to have been reduced by a third due to these two factors.

In addition to these facts, there are some historians who associate typhus with the disease that struck Athens in the century of Pericles, 430 BC

The period became known as the Plague of Athens, the Plague of Athens or the Plague of Egypt. It turns out that the epidemic came and made its victims, but it is not known exactly what caused it. Typhus is among the diseases that may have been the causes. In addition to typhus, they are considering bubonic plague, smallpox and influenza as causing the deaths.

Types of typhus

There are three main types of typhus: epidemic, endemic and bush typhus. They differ, basically, by the causative bacteria. Know what they are:

Epidemic typhus

Epidemic typhus, also known as exanthematic, is caused by a bacterium called Rickettsia prowazekii. It is very common for transmission to occur because of the body louse ( Pediculus humanus corporis ) or, more rarely, by hair louse.

The contamination happens due to the contact of the bacteria expelled in the lice feces with possible skin wounds.

These bacteria reproduce inside the endothelial cells, responsible for lining blood vessels. This is how the inflammation happens.

Endemic typhus

In this type of typhus, rats are the main vectors of the disease. The bacterium responsible for causing this pathology is Rickettsia typhi . Endemic typhus can also be known as  murine typhus.

When there is a large number of contaminated rodents, it is easier for transmission to humans to happen. This is because the flea Xenopsylla cheopis  is forced to search for new hosts, because, with the increase in animals infected and killed by the disease, the greater the number of bacteria that need to find a new “home”.

This is a much more common disease in islands and port regions. The way it evolves is very similar to that of epidemic typhus. However, it has less frequent complications and less harmful symptoms.

To treat patients with this disease, antibiotics are used and, for prevention, it is necessary to maintain basic hygiene conditions and contain the proliferation of rats.

Tifo do mato

This type of typhus is caused by the bacterium Orientia tsutsugamushi and can be deadly. The main transmitters of the disease are wild mice.

In Asia, where it is more common, the disease kills at least 140,000 people a year. The first time they registered the presence of this disease in South America was in 2006, in Chile.

It is not known how the bacteria got to Chiloé Island, 12,000 kilometers from Asia. One hypothesis is that it has always been there and only this year it caused the disease in someone.

The patient with typhus from the bush has symptoms such as fever, headaches, muscle pain and spots on the body. Its most characteristic sign is a black wound on the skin, similar to a cigarette burn. This means that this is where the bacteria settled.

Although it can be lethal, in cases that have worsened, bush typhus has treatment. For this, the doctor must recommend the use of specific antibiotics.

Causes

Typhus is an infectious disease classified as rickettsial because it is caused by bacteria that are part of the genus Rickettsias . The disease occurs in people when bacteria are transmitted by vectors, such as fleas , rats and ticks.

Bacteria develop within the intestinal cells of these vectors (lice, fleas, etc.) and, when they release their waste, the bacteria are released. Generally, contact with other organisms occurs through wounds or fissures in the skin.

These wounds often appear as a reaction to the itch caused by the parasites themselves, like someone who has lice and scratches himself for the irritation they cause.

The types of typhus, therefore, are caused by these bacteria. Each typhus (endemic, epidemic or forest typhus) has a specific bacterium that causes the pathology. Are they:

Rickettsia prowazekii

This is the bacteria responsible for causing epidemic typhus. It affects, in addition to humans, animals such as oxen, sheep and goats.

The Rickettsia prowazekii  is transmitted through the feces of human lice or the dead bodies of the parasite and is only able to replicate in host cells. It is not common, but it can also happen through the bite of parasites.

Its cycle consists of finding a vertebrate host (humans) and then finding an invertebrate host (lice, ticks and mites).

The Rickettsia prowazekii  remains infectious for a month in these invertebrates. After spreading, the bacteria remains in these new bodies for a period of 2 to 30 days until symptoms appear. This time is also known as the incubation period.

The time that the symptoms will remain in the patient can vary, but the common thing is that it lasts from 1 to 3 days, when treated correctly.

There is a curiosity about this bacterium and its discovery. A Brazilian doctor, named Henrique da Rocha Lima, was responsible for describing the bacterium, for the first time, in 1916. He had the help of his colleague Stanislaus von Prowazek.

Both were contaminated with typhus during a study of the causative agent. The research was carried out in a hospital inside a prison in Hamburg, Germany. Prowazek did not survive the disease and died the year before the discovery of the bacteria. The name of the bacterium was chosen in honor of the colleague who died trying to discover it.

Rickettsia typhi (Rickettsia mooseri)

Formerly known as Rickettsia mooseri , this is the bacterium responsible for endemic typhus.

It has rodents as its main reservoirs. Therefore, its transmission happens, most of the time, through rats fleas ( Xenopsylla cheopis ). However, mites and lice are also vectors. In addition to these animals, they can also breed in armadillos, cats and cangambás.

Orientia tsutsugamushi

The Orientia tsutsugamushi  is responsible for causing the bush typhus, the deadliest form of the disease. This bacterium is carried by dust mites. The main animal that transmits the disease is the wild rat, a common species in Europe and Asia, the continent with the highest cases of the disease.

Streaming

The transmission of typhus occurs by the bite or bite of infected insects, such as lice, rat fleas or ticks. It also occurs through contamination by feces. This is how the causative bacteria enter the human body.

When installed in the body, they find in the endothelial cells of blood vessels a place to proliferate, as they do not survive without host cells.

However, before these bacteria actually cause disease in humans, they first reach the parasites.

Lice, for example, are infected through their own food, when they suck the blood of a person infected by the disease. As if it were a cyclical behavior of the disease.

These bacteria settle in the intestines of these insects and multiply there. The bacterial colony grows so much that it ends up causing an explosion of the intestinal cells.

Thus, the bacteria spread through the parasite’s intestinal canal, which ends up dying from this invasion and transmitting the disease to other organisms through the feces.

Risk factors

The risk of having the disease is higher for some people, considering the living conditions and the place where they live. Some factors contribute to typhus becoming an epidemic. Get to know:

Poor hygiene conditions

People who live in countries with poor basic sanitation and hygiene conditions are part of a scenario in which the disease can proliferate.

Typhus, in almost all types, has a strong connection to the issue of cleaning and controlling parasites. In places where rodents such as rats and ticks are common, the risk of having contact with the bacteria causing the disease is greater.

Rural areas

People who live with animals (oxen, goats and sheep) who are among the possible carriers of the disease are also at risk. In this case, professionals and people who deal with these animals must be more concerned with the appearance of ticks and fleas, for example.

In more rural areas, contact with animals such as oxen, goats and sheep may be greater. For this reason, they are considered areas of risk. However, we must also consider the presence of parasites in urban areas and take preventive measures to contain them, such as preventing the proliferation of fleas in domestic animals.

Symptoms

The symptoms of epidemic typhus are similar to those of Influenza, the H1N1 flu. After the time of incubation of the disease, the first signs begin to appear. It usually happens between one or two weeks after contact with the bacteria and its reproduction in the patient’s body.

Some signs of typhus can be confused with signs of other diseases, such as endemic typhus. It has, in some cases, the maculopapular rash as a symptom. This is a type of skin lesion characteristic of redness and small papules (a kind of lump) in the affected area.

In the case of typhus, this lesion is concentrated on the trunk, but does not remain for long. Because it is common in other diseases, it can be mistaken for measles and rubella .

Symptoms of epidemic and endemic typhus are similar, but vary in duration and intensity. In the epidemic form, the signs remain for a longer time and may have greater complications.

Already in the typhus of the bush, the main feature is an injury that resembles a cigarette burn. In this wound, usually small and black in color, it identifies the place where the bacteria settled.

Among the signs of the disease that can appear in different types are:

  • Severe headaches;
  • Joint pain;
  • High fever (39º to 40º C);
  • Fatigue;
  • Chills;
  • Red spots (rash) on the body, with the exception of the face, palms and soles of the feet;
  • Weakness;
  • Sickness;
  • Vomiting.
  • Diarrhea;
  • Cough.

Some symptoms, in addition to these, appear when the disease is advanced. Are they:

Delusions

In a severe condition, the patient with typhus may have impaired brain function. He may appear to be confused, disoriented or having trouble staying focused.

Stupor

It is a state of immobilization. The patient who has this symptom has a suspension of physical and psychological activity. Although conscious, it does not respond to external stimuli.

Bleeding

They are excessive blood loss, which can be an external or internal hemorrhage, through the holes in the body or cuts.

Pneumonia

Infection that affects the body, but that affects mainly the lungs.

Thrombosis

Formation of clots inside veins and arteries, which prevents blood circulation properly. It causes pain and swelling in the legs and arms.

Vasculitis

Group of diseases that cause inflammation of blood vessels.

Gangrena

It is a type of necrosis caused by the death of a tissue. It usually happens due to a failure in blood supply and lack of oxygen. The gangrene can result from an untreated vasculitis.

Myocarditis

Inflammation of the myocardium, the thickest muscle layer of the heart wall.

Uremia

It is the accumulation of urea in the blood, a toxic substance that is produced by the liver after eating proteins . The excess of urea happens when the kidneys, responsible for filtering the toxin, suffer some type of insufficiency.

Bleeding from the skin (or petechiae)

Petechia is the name given to small purple spots on the skin. It is through these spots that bleeding occurs.

Circulatory shock

This is a condition characterized by the inability of the cardiovascular system to maintain the blood necessary for tissue oxygenation.

How is typhus diagnosed?

The diagnosis of typhus is made by a general practitioner  or infectious disease . It can be difficult for doctors, as the symptoms resemble those of other diseases, such as dengue , malaria and brucellosis, an infectious disease caused by the bacteria  Brucella .

Performing the diagnosis correctly contributes to the adequate treatment guidance. There is, however, an exception to the order of this procedure. The common thing is that you first have the diagnosis and then start the specific treatment.

This exception occurs when there is a suspicion of spotted fever, a rickettsial disease caused by bacteria of the Rickettsiaceae type  the same as typhus – and transmitted by tick bites. Because it is a disease with greater severity, treatment is started even before the differential diagnosis is completed.

The main forms of diagnosis of typhus are:

Laboratory tests

Laboratory tests are performed to identify the bacteria that cause typhus. Are they:

Western blot (immunoenzymatic assay)

This test aims to find the antibodies present in the body that indicate the presence of the disease’s bacteria.

Immunofluorescence

It is possible that a blood or immunofluorescence test is performed.

In this exam, a fluorescent dye is used to find typhus in a sputum sample, a thick liquid produced by our body when there is swelling of the mucous membranes.

Popularly, it is known as phlegm and its more yellowish color can indicate infections in the respiratory system.

Cell culture

For typhus, it is also possible to perform a microscopic observation after cell culture. This diagnosis uses cells collected from fertilized eggs from chickens. In this observation, the objective is to confirm the antibodies that fight the disease bacteria.

For this, they use DNA detection with the help of the PCR technique .

C-reactive protein

PCR is the test that allows measuring the dosage of C-reactive protein, hence the acronym. It is done by collecting blood from the patient, as it is the main indication of inflammatory processes or necrosis (tissue death) in the human body.

To investigate bacterial inflammation, as in the case of typhus, this is the most suitable test.

Symptoms

In addition to laboratory tests, the symptoms presented by patients are taken into account, such as signs of severe headaches, fever, fatigue , red spots, etc.

Atmosphere

It is important for the diagnosis to consider the places the patient has recently visited and the place where he lives, as they may belong to risk factors. This is also important to understand where the disease originated and helps to map risk sites.

Tifo tern care?

Typhus is a disease that can be cured . It is caused by bacteria that cause inflammation in patients, which can affect humans and animals. Although it can have more serious complications, typhus (epidemic, endemic or from the bush) has treatment and can be reversed.

What is the treatment?

The treatment of this disease is fast and basically consists of three forms. Get to know:

Medicines

Most cases of typhus are treated with antibiotics . After the diagnosis of the disease, the doctor must prescribe antibiotics specific to the type of typhus that affected the patient.

In severe cases, it may be necessary to indicate corticosteroid drugs , which relieve symptoms.

Intravenous medications

For some patients of the epidemic typhus, it may also be necessary to use intravenous medications and oxygen supplements to reach the bacteria present in the bloodstream and elsewhere in the body affected.

This option allows an efficient treatment by speed, as it is injected directly into the blood.

Vaccine

There is also the possibility of using the vaccine. It was developed during the Second World War, but it is not very common to use this treatment today.

Vaccination is very important to contain major epidemics, but as patients respond well to the use of antibiotics, it is used only when there are outbreaks of endemic typhus in more vulnerable populations.

Typhoid medications

The drugs used to treat typhus are antibiotics. In some cases, the use of anti-inflammatory drugs is recommended to contain the symptoms. The main ones are:

  • Chloramphenicol ;
  • Tetracycline ;
  • Cortiscosteroides;
  • Tetraciclinas;
  • Azithromycin ;
  • Doxycycline ;
  • Ciprofloxacin (for patients who cannot use doxycycline).

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living / Prognosis

Typhus is a disease with a high chance of good recovery and control. When in good sanitary and hygienic conditions, the transmitters of the disease do not gain space to cause epidemics or deaths.

However, this is not a reality everywhere. In regions where people live in clusters and with poor hygiene conditions, the risk of complications from the disease is greater. This is also true for people who cannot afford immediate treatment.

When treatment is inadequate, typhus mortality is 20%. In places where malnutrition is high, mortality can be 66%, which means that the disease is lethal in 2 out of 3 infected with the disease.

The delay in a treatment or diagnosis is among the challenges to contain the disease definitively.

Complications

Typhus can be a lethal disease, as seen in major epidemics in the past. Currently, although rarer, it can also be a dangerous pathology. Know the possible complications of this disease:

Aggravated symptoms

Symptoms in their severe cases also carry great risks for patients, as in cases with thrombosis , gangrene, vasculitis, myocarditis, uremia and other complications.

Brill-Zinsser disease

In some cases, the condition can cause a secondary infection known as Brill-Zinsser disease. This infection arises years after the typhus-causing bacteria settles in the body.

When any of these bacteria hide inside the cells in which they settle at the beginning of the disease, they can lead to the onset of this new infection. Symptoms are similar to those of typhus, but are more moderate.

The discomfort is knowing that these bacteria, even with treatment, can remain inactive in the body and appear years later. It is not common, but it can happen.

How to prevent typhus?

To prevent typhus, some basic measures can be taken. Get to know:

Personal hygiene care

One of the main vectors of the disease is lice. In this case, it is important to have control over the appearance of these insects. When you notice these unpleasant presences, both because of the danger of having contact with the typhus bacteria and because of the itching, look for measures to contain the proliferation of these bugs.

It is common for children to be more vulnerable to catching lice, so some precautions are recommended:

  • Avoid sharing personal items such as combs, caps and pillows;
  • Be careful when leaning your head against any shared seat, such as at the cinema, bus and plane;
  • When infected, use the right products, for a set time, to contain the insects;
  • Wash body and bedding thoroughly, preferably in hot water;
  • Plush toys must also be sanitized.

Beware of pets

Watch out for your pets and the appearance of itching. They can also be affected by typhus or serve as hosts for the transmitting parasites, such as lice, fleas and ticks.

Although the species of lice that parasite these animals are different from those that bother humans, they can also contain the disease’s bacteria.

However, ending these “plagues” is not easy. For example, a single female flea is capable of laying 25 to 30 eggs a day.

Caring for the hygiene of the animals and the environment in which they live are some of the ways to eliminate parasites.

Washing curtains, rugs, cloths in which to lie down, houses or any environment in which they spend the day is a start to prevention.

For the treatment, there are some options of flea shampoos, collars and products that fight insects. Likewise, care should be taken with lice and ticks.

Proliferation of rats

In addition to typhus, rats are at risk of transmitting another serious disease: leptospirosis . Several factors increase the possibility of infestation of these rodents, such as tall vegetation, debris in the yard and the climate.

The proliferation of rats in autumn is more common, with temperature variations and constant rains.

So that they are not present in your home environment and there is no risk of having contact with the diseases that it brings, some tips can be followed:

  • Keep the water tanks always closed;
  • Be careful with organic waste outdoors;
  • Keep the garbage separate and tightly closed for collection;
  • Do not accumulate debris inside or near the house;
  • Keep the garden clean;
  • Organize the place where you store your food (pantry) and keep it always very clean;
  • Rations of domestic animals, preferably, should be in high places and away from the walls.

Typhus is an infectious disease caused by bacteria and is transmitted by host parasites. Fortunately, it has treatment and, currently, it does not cause major epidemics. The disease can be prevented with good conditions of basic sanitation and hygiene.

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