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Epidemic typhus

Daniel J Sexton, MD
Micah T McClain, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Epidemic typhus is a potentially lethal, louse-borne, exanthematous disease caused by Rickettsia prowazekii. R. prowazekii is one of two members of the typhus group of Rickettsia known to cause human illness; the other member, Rickettsia typhi, causes murine typhus. Scrub typhus is caused by Orientia tsutsugamushi. Like all rickettsiae, R. prowazekii cannot be grown on cell-free media, and specialized laboratory facilities are required to recover the organism from clinical specimens.

The epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of epidemic typhus will be discussed here. Topic reviews that discuss murine typhus and scrub typhus are found elsewhere. (see "Scrub typhus: Clinical features and diagnosis" and "Scrub typhus: Treatment and prevention" and "The epidemiology and clinical manifestations of murine typhus" and "Diagnosis and treatment of murine typhus")


The first description of epidemic typhus was thought to be made in 1546 by an Italian physician, Girolamo Fracastoro, who separated epidemic typhus from other typhus-like infections. It remains controversial as to whether typhus was imported into Europe from the New World or vice versa [1].

Throughout the Middle Ages and into the early part of the 20th century, periodic epidemics of R. prowazekii 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 [2]. It has been estimated that epidemic typhus has caused more deaths than all the wars in history [3].

Epidemic typhus is now a rare disease, but subsequent developments illustrate that an understanding of its epidemiology, clinical features, and treatment is still important to clinicians:

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Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
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