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Epidemic typhus

Daniel J Sexton, 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 three members of the typhus group of Rickettsia known to cause human illness; the other two members cause murine typhus and scrub typhus. 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.

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 [1]. It has been estimated that epidemic typhus has caused more deaths than all the wars in history [2].

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

A sylvatic cycle of infection (ie, disease transmitted from wild animals, particularly flying squirrels and their ectoparasites, with secondary transmission to humans) has been reported in the United States [3].

More than 45,000 cases of epidemic typhus occurred in Burundi in association with civil war during the 1990s; body louse infestation preceded outbreaks of both epidemic typhus and trench fever due to Bartonella quintana [4].


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Literature review current through: Sep 2016. | This topic last updated: Dec 7, 2015.
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