Materiały źródłowe

• #1 Department of Public Health – Acute Communicable Disease Control

  http://www.publichealth.lacounty.gov/acd/vectortyphus.htm

  Flea-borne typhus (sometimes called murine typhus) is the only one of these diseases naturally occurring in LA County and is caused by Rickettsia typhi bacteria. Flea-borne typhus can spread to humans from bacteria found in infected fleas. Infection happens when the feces from infected fleas are rubbed into cuts or scrapes in the skin or rubbed into the eyes. Symptoms can start within two weeks after contact with the infected flea and include high fever, headache, chills, and body aches. A rash can appear on the chest, back, arms, or legs. In rare cases, there may be swelling at the lining of the brain (meningitis) and heart valves (endocarditis). Fatalities are uncommon, occurring in less than 1% of cases. The disease is typically mild in young children. Typhus infection is not vaccine preventable, but can be treated with antibiotics.

• #2 Typhus: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001363.htm

  Typhus is a bacterial disease spread by lice or fleas. […] Treatment includes the following antibiotics: Doxycycline, Tetracycline, Chloramphenicol (much less common). […] People with epidemic typhus may need oxygen and intravenous (IV) fluids. […] People with epidemic typhus who receive treatment quickly should completely recover. Without treatment, death can occur, with those over age 60 having the highest risk of death. […] Contact your provider if you develop symptoms of typhus. This serious disorder can require emergency care. […] Avoid being in areas where you might encounter rat fleas or lice. Good sanitation and public health measures reduce the rat population.

• #3 Typhus: Fever, Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/typhus

  Symptoms of typhus include high fever, chills, body aches, headache, rash, cough, vomiting, stomach pain, confusion and more. […] Symptoms of typhus can include: High fever (over 104 degrees Fahrenheit/40 degrees Celsius) that can last several days or weeks. […] Left untreated, typhus can lead to multiple complications, including: Blood clots. […] Yes, antibiotics can cure a typhus infection. Providers usually treat murine, epidemic and scrub typhus with doxycycline. […] The best way to prevent typhus is to avoid flea, lice and chigger bites. […] If you have typhus, expect to take antibiotics for three days to two weeks, depending on the type. […] When treated early with antibiotics, all types of typhus have a good prognosis (outlook).

• #4 Health & Human services

  https://www.longbeach.gov/health/diseases-and-condition/information-on/typhus/

  Symptoms begin within 2 weeks after contact with infected fleas. Signs and symptoms may include: Fever, Headache, Chills, Loss of appetite, Nausea, Vomiting, Cough, Muscle pain, Rash. […] See your healthcare provider if you develop symptoms of typhus after coming into contact with fleas. Your provider can do a blood test to look for typhus. […] Flea-borne typhus can be treated with antibiotics. The treatment is most effective when given soon after symptoms begin. […] Make sure your cats and dogs are free of fleas. Additional steps include: Do not leave pet food outdoors, Avoid debris and overgrown vegetation that may harbor wild animals, Do not provide food or water for wild animals, including feral cats, Store trash in cans with secure lids, Apply an EPA-registered insect repellent labeled for use against fleas when outdoors.

• #4 Health & Human services

  https://www.longbeach.gov/health/diseases-and-condition/information-on/typhus/

  The Long Beach Department of Health and Human Services (Health Department) encourages residents to take steps to protect themselves and their families from flea-borne typhus. Long Beach has recorded the most cases of typhus in 2021 than any previous year. The Health Department continues to provide education to residents, health care providers, and veterinarians, who all play an important part in stopping the spread of the disease in Long Beach. […] Flea-borne typhus (also called murine typhus) is caused by the bacteria (Rickettsia typhi) and is transmitted by infected fleas, which enter the skin through scratching following a bite or an any cuts or scrapes. Infected fleas can be carried by rats, domestic or feral cats, dogs, raccoons and opossums. […] Typhus can affect people of all ages. Most infected patients do not recall a fleabite, but often have contact with animals such as pet dogs or cats that carry these fleas in or near their home. Pets and other animals do not become sick from typhus.

• #5

  https://www.health.nsw.gov.au/Infectious/factsheets/Pages/typhus.aspx

  Epidemic typhus is a serious bacterial infection spread by human body lice and is a risk in conflict settings and refugee camps. […] In most forms of typhus, symptoms usually develop 1 to 2 weeks after exposure. Common symptoms include fever, chills, headache, muscle aches, and malaise. […] Epidemic and scrub typhus are usually associated with more severe symptoms which typically begin suddenly. […] In epidemic typhus outbreaks where there is no access to antibiotic treatment, from 10 to 40 per cent of cases are fatal. […] The best way to prevent typhus infections is to minimize exposure to the ectoparasite vectors (human body lice, fleas, ticks and mites) and rodents which may carry infected fleas. […] People at increased risk epidemic typhus include those who work with displaced populations in impoverished areas, such as in refugee camps. […] Antibiotics are generally only used for treatment of symptomatic typhus infections.

• #6 The epidemiology, diagnosis and management of scrub typhus disease in China

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8437466/

  Thirty-nine years ago, scrub typhus (ST), a disease, was not among the Chinas notifiable diseases. However, ST has reemerged to become a growing public health issue in the southwest part of China. […] Most patients with ST that receive appropriate treatment recover from this disease. However, delayed diagnosis and improper management of ST can result in severe complications and even death. […] A key diagnostic indicator of ST is the presence of eschar. […] Notably, ST also can be treated successfully using antibiotics; in particular, doxycycline, tetracycline, azithromycin, and rifampicin have been applied as the first line of medications for ST treatment, but that have led to few treatment failures. […] While the ST is a bacterial disease, an antibiotics (chloramphenicol, tetracycline, and doxycycline) have been used to treat the disease.

• #6 The epidemiology, diagnosis and management of scrub typhus disease in China

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8437466/

  Therefore, antibiotic resistance of ST has led to considerations for the improvement of treatment protocols and the need for enhanced public health awareness. […] Timely diagnosis can improve the success rate of treatment. […] Antimicrobial therapy using doxycycline or azithromycin antibiotics in febrile patients before a diagnosis can reduce the morbidity and mortality associated with the disease. […] However, despite continuous efforts to develop effective vaccines, this objective remains unfulfilled. […] The changing epidemiology of ST in China warrants an enhanced disease control and prevention program.

• #7 Severe scrub typhus infection: Clinical features, diagnostic challenges and management

  https://www.wjgnet.com/2220-3141/full/v4/i3/244.htm

  Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. […] The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%.

• #7 Severe scrub typhus infection: Clinical features, diagnostic challenges and management

  https://www.wjgnet.com/2220-3141/full/v4/i3/244.htm

  Scrub typhus is an important differential diagnosis in patients who present with acute undifferentiated fever in South East Asia. Since the presentation may be non-specific, with features of organ failure in those with severe infection, early diagnosis and appropriate management is crucial. The presence of an eschar suggests scrub typhus infection. The diagnosis may be confirmed on serological assays, the reference test being the indirect immunofluorescence test for the detection of IgM antibodies. In those with mild infection, fever defervescence occurs in about 2-d with Doxycycline therapy. […] Patients with mild disease presenting with fever without organ dysfunction may require only antipyretics along with antibiotics. Patients presenting with organ dysfunction would need organ support depending on the nature and extent of organ dysfunction. Patients with respiratory failure could be supported either by means of non-invasive or invasive mechanical ventilation based on standard criteria in the management of respiratory failure.

• #8 Scrub typhus update: A re‑emerging global threat beyond the Tsutsugamushi Triangle and the physiological ramifications of scrub typhus infection (Review)

  https://www.spandidos-publications.com/10.3892/wasj.2025.322

  Scrub typhus, caused by Orientia tsutsugamushi, is a miteborne zoonotic disease endemic to Asia and the Pacific. […] The disease presents with flulike symptoms, including fever, rash and eschar formation, but can progress to severe complications, such as acute encephalitis syndrome and multiorgan dysfunction syndrome. […] Early treatment with antibiotics, such as doxycycline or azithromycin markedly reduces morbidity and mortality rates. […] Scrub typhus has drawn considerable attention after thousands of confirmed cases and several fatalities were reported in India during 2023. […] Neurological complications (meningitis, meningoencephalitis, encephalopathy and seizures) have been shown to be associated with high mortality rates in these patients. […] Scrub typhus can lead to acute kidney injury through several mechanisms.

• #8 Scrub typhus update: A re‑emerging global threat beyond the Tsutsugamushi Triangle and the physiological ramifications of scrub typhus infection (Review)

  https://www.spandidos-publications.com/10.3892/wasj.2025.322

  Scrub typhus is effectively treated with antibiotics, such as doxycycline (preferred), azithromycin or chloramphenicol. […] Early empirical therapy is recommended based on clinical suspicion, as fever reduction is often observed within 48 h of initiating doxycycline. […] Preventive measures primarily involve the use of insect repellents, such as N,N-diethyl-meta-toluamide, which offers effective but short-term protection against mites and ticks during travel in areas where the disease is endemic. […] Scrub typhus symptoms often mimic other illnesses, rendering diagnosis challenging. […] Early diagnosis and treatment are crucial for a full recovery. […] By addressing these underlying socioeconomic factors, a more resilient environment can be created and the impact of the disease can be minimized.

• #9

  https://link.springer.com/article/10.1007/s12098-023-04983-1

  Scrub typhus is the most common rickettsial infection in India. There have been many outbreaks of pediatric scrub typhus reported from several endemic regions in India in the last decade. The present study was planned to study clinical, biochemical, complications and predictors of morbidity and mortality of pediatric scrub typhus. […] The most common symptoms were fever (100%), hepatomegaly (69.9%), vomiting (55.4%), facial puffiness (54.2%), rashes (51.8%) and lymphadenopathy (21.7%). […] The most common complication was hepatitis (51.5%), followed by acute encephalitis syndrome (37.9%), pneumonia (34.8%) and platelet count50,000/L (34.8%). […] Mortality was 12.04%. This study can guide the policy makers to streamline the health budget for reducing morbidity and mortality, attributed to scrub typhus.

• #10 Orientia tsutsugamushi (Scrub Typhus) | Public Health Ontario

  https://www.publichealthontario.ca/en/Laboratory-Services/Test-Information-Index/Orientia-Tsutsugamushi

  Testing is indicated for individuals with a history of exposure to mites in endemic areas and clinical presentation compatible with suspected scrub typhus. […] For serology, collecting both an acute serum (collected early after the onset of symptoms) and a convalescent serum (collected 2-3 weeks later) may be required for laboratory confirmation of infection. […] For PCR, samples should ideally be collected prior to the initiation of antibiotic therapy, but treatment should never be withheld, if required based on the patients clinical status. […] A positive IgM and IgG result does not distinguish active versus remote infection unless paired sera are collected demonstrating seroconversion. […] Results are reported to the physician, authorized health care provider (General O. Reg 45/22, s.18) or submitter as indicated on the requisition.

• #11 Burden of scrub typhus among patients with acute febrile illness attending tertiary care hospital in Chitwan, Nepal | BMJ Open

  https://bmjopen.bmj.com/content/10/9/e034727

  The gold standard test for scrub typhus is indirect immunofluorescence assay which is not used in this study, that would have been the best indicator to find sensitivity and specificity of other tests. However, the scrub typhus IgM ELISA is a flexible alternative to the IFA technique. It has sensitivity and specificity of more than 90.0% for detecting specific antibodies. […] This study implies the emergence of scrub typhus. Although the disease is endemic in our country, it is grossly underdiagnosed owing to non-specific clinical presentations and lack of affordable and reliable diagnostic facilities. Thus, it is recommended that high index of suspicion should be maintained for cases presenting with acute febrile illness. Unfortunately, there is no effective vaccine against scrub typhus and the disease still persists. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. Delay in diagnosis and treatment can be fatal and may lead to complications and higher mortality. Hence, early diagnosis and prompt institution of effective antibiotic therapy is mandatory. Surveillance and public health awareness about the disease transmission and preventive measures need to be initiated.

• #11 Burden of scrub typhus among patients with acute febrile illness attending tertiary care hospital in Chitwan, Nepal | BMJ Open

  https://bmjopen.bmj.com/content/10/9/e034727

  Scrub typhus is an emerging neglected tropical disease, reported from many parts of Asia including Nepal. This study aims to determine the seroepidemiology of scrub typhus among febrile patients attending Chitwan Medical College Teaching Hospital (CMC-TH), Bharatpur, Nepal. […] High prevalence of scrub typhus implies that patients with acute febrile illness should be investigated for scrub typhus with high priority. There is utmost need of reliable diagnostic facilities at all levels of healthcare system in Nepal. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. More sustain and vigorous awareness programmes need to be promoted for early diagnosis, treatment and control. […] The scrub typhus IgM ELISA is a flexible alternative to the indirect fluorescent assay technique. It has sensitivity and specificity of more than 90.0% for detecting specific antibodies.

• #12 Typhus

  https://www.nhs.uk/conditions/typhus/

  Typhus is an infection spread by lice, fleas or mites. It’s very rare in the UK. It can be serious, but most people make a full recovery if treated quickly. […] It’s important to get diagnosed early so treatment can be started as soon as possible. If typhus is not treated quickly, it can sometimes be life-threatening. […] Antibiotics are used to treat a typhus infection. They’re usually started before you get your test result, as this can take up to a week. […] Most people start to feel better within 48 hours of starting treatment. It’s important to keep taking your antibiotics until they’re finished, even if you feel better. […] People with severe typhus may need to be treated in hospital.

• #13 Murine Typhus | Disease Outbreak Control Division

  https://health.hawaii.gov/docd/disease_listing/murine-typhus/

  Murine typhus is a disease carried by rodents (rats, mice, mongoose) and spread to humans by fleas. It is caused by a bacteria called Rickettsia typhi. […] A doctor can prescribe antibiotic medicine to treat typhus. Antibiotics are more effective when given soon after symptoms begin. […] Mortality rate is low with a use of antibiotic treatment. Due to long waiting period for clinical test result and highly chance of false negative result with acute sample, it is recommended to use antibiotic treatment promptly without waiting for the test result.

• #14 About Epidemic Typhus | Typhus Fevers | CDC

  https://www.cdc.gov/typhus/about/epidemic.html

  Epidemic typhus should be treated with the antibiotic doxycycline. […] Antibiotics are most effective when given soon after symptoms begin. People who are treated early with doxycycline usually recover quickly.

• #15 Information for Health Care Providers

  http://med.iiab.me/modules/en-cdc/www.cdc.gov/typhus/healthcare-providers/index.html

  Scrub typhus is transmitted to humans through bites from infected larval trombiculid mites, commonly known as chiggers. […] It is important to treat scrub typhus early in the course of the disease in order to avert life-threatening complications. […] Doxycycline is the treatment of choice for suspected scrub typhus in persons of all ages. […] Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement. […] Doxycycline is the treatment of choice for suspected cases of murine typhus in adults and children of all ages. […] Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement (usually 7-10 days). […] Doxycycline is the treatment of choice for suspected cases of acute epidemic typhus and Brill-Zinsser disease in adults and children of all ages. […] Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement (usually 7-10 days).

• #16 Typhus Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/typhus

  Typhus is a bacterial disease spread by lice or fleas. […] Treatment includes the following antibiotics: Doxycycline, Tetracycline, Chloramphenicol (much less common). […] People with epidemic typhus may need oxygen and intravenous (IV) fluids. […] Contact your provider if you develop symptoms of typhus. This serious disorder can require emergency care. […] Avoid being in areas where you might encounter rat fleas or lice. Good sanitation and public health measures reduce the rat population. […] Measures to get rid of lice when an infection has been found include: Bathing, Boiling clothes or avoiding infested clothing for at least 5 days (lice will die without feeding on blood), Using insecticides (10% DDT, 1% malathion, or 1% permethrin).

• #17 Typhus: Symptoms, Causes, Diagnosis, Treatment, Prevention

  https://www.webmd.com/a-to-z-guides/what-is-typhus

  Doctors can easily treat all three kinds of typhus with antibiotics. But they can cause serious illness, so get treatment right away if you think you might have been exposed to it. […] The most effective therapy for all three kinds of typhus is the antibiotic doxycycline. […] A single dose of doxycycline has proved effective against epidemic typhus. Doxycycline also works quickly on other strains of the disease. […] For the best results, you should take it as soon as possible after your symptoms start. […] If youre allergic to doxycycline or if it doesnt work, doctors may choose another antibiotic such as ciprofloxacin (Cipro).

• #18 Typhus Treatment & Management: Medical Care, Activity, Prevention

  https://emedicine.medscape.com/article/231374-treatment

  Antibiotics are the standard of care in the treatment of typhus. Continue antibiotics for 48-72 hours after the fever has resolved. A second course of antibiotic therapy usually is curative in cases of recrudescent typhus. […] Other supportive measures may be used as necessary. […] Inpatient care may be required for ill patients with typhus who cannot maintain adequate oral hydration/intake or enteral antibiotic therapy. […] Patients with complications from typhus may need inpatient care for further diagnosis, evaluation, and management for these disorders (see Complications).

• #19 Typhoid Fever (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/typhoid.html

  Typhoid fever is treated with antibiotics that kill the bacteria. It’s important for people with typhoid fever to take the medicine for the whole time that the doctor prescribes, even if they feel better. Stopping too soon means some bacteria could remain. […] Most people start feeling better within 2–3 days of starting treatment. They should drink plenty of fluids to prevent dehydration. Someone who gets severely dehydrated due to diarrhea might need to get IV (intravenous) fluids in a hospital or other medical care facility. […] If your child has typhoid, acetaminophen can help reduce fever and make them feel more comfortable. Call a doctor right away if your child’s symptoms last, if they go away and come back, or if your child has any new symptoms. […] People with typhoid fever should stay home until the disease has run its course and a doctor makes sure that the bacteria are gone. Those who work in the food service industry may not legally be allowed to return to work until a doctor has proved they are free of the bacteria.

• #20 Typhus: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001363.htm

  Typhus is a bacterial disease spread by lice or fleas. […] Treatment includes the following antibiotics: Doxycycline, Tetracycline, Chloramphenicol (much less common). […] People with epidemic typhus may need oxygen and intravenous (IV) fluids. […] People with epidemic typhus who receive treatment quickly should completely recover. Without treatment, death can occur, with those over age 60 having the highest risk of death. […] Contact your provider if you develop symptoms of typhus. This serious disorder can require emergency care. […] Avoid being in areas where you might encounter rat fleas or lice. Good sanitation and public health measures reduce the rat population.

• #21 Clinical and laboratory findings associated with severe scrub typhus | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-10-108

  Scrub typhus is a mite-borne bacterial infection of humans caused by Orientia tsutsugamushi that causes a generalized vasculitis that may involve the tissues of any organ system. […] Our results suggest that clinicians should be aware of the potential for complications, when scrub typhus patients are older ( 60 years), presents without eschar, or laboratory findings such as WBC counts 10, 000/mm3, and serum albumin level 3.0 g/dL. Close observation and intensive care for scrub typhus patients with the potential for complications may prevent serious complications with subsequent reduction in its mortality rate. […] The presence of one or more of these four risk factors for severe scrub typhus should alert physicians to provide close monitoring and intensive care, which can prevent severe morbidity or mortality.

• #22 Typhoid Fever Nursing Care Management Study Guide – Nurseslabs

  https://nurseslabs.com/typhoid-fever/

  Typhoid Fever Nursing Care Management […] Nursing management of a patient with typhoid fever include the following: […] Assessment of a patient with typhoid fever include: […] Based on the assessment data, the major nursing diagnosis for typhoid fever are: […] The major nursing care planning goals for typhoid fever: […] The following are the nursing interventions for a patient with typhoid fever: […] Nursing goals for typhoid fever are met as evidenced by: […] Documentation in a patient with typhoid fever include:

• #23 Flea-borne Typhus | Texas DSHS

  https://www.dshs.texas.gov/notifiable-conditions/zoonosis-control/zoonosis-control-diseases-and-conditions/flea-borne-typhus

  People with typhus report non-specific symptoms including fever, headache, chills, malaise, anorexia, myalgia, rash, nausea, and vomiting. Laboratory findings may include thrombocytopenia, hyponatremia, elevated hepatic transaminases, and CSF abnormalities consistent with aseptic meningitis. Although flea-borne typhus is often a relatively mild, self-limited illness, more than 60% of reported cases are hospitalized. When left untreated, severe illness can cause damage to one or more organs, including the liver, kidneys, heart, lungs, and brain. As with other rickettsial infections, prompt antibiotic treatment is recommended; treatment should not be delayed pending diagnostic tests.

• #24

  https://www.who.int/news-room/fact-sheets/detail/typhoid

  Typhoid fever can be treated with antibiotics although increasing resistance to different types of antibiotics is making treatment more complicated. […] Typhoid fever can be treated with antibiotics. Antimicrobial resistance is common with likelihood of more complicated and expensive treatment options required in the most affected regions. […] It is important for people being treated for typhoid fever to do the following: Take prescribed antibiotics for as long as the doctor has prescribed. Wash their hands with soap and water after using the bathroom and avoid preparing or serving food for other people. This will lower the chance of passing the infection on to someone else. Have their doctor test to ensure that no Salmonella Typhi bacteria remain in their body. […] Access to safe water and adequate sanitation, hygiene among food handlers and typhoid vaccination are all effective in preventing typhoid fever.

• #25

  https://www.collincountytx.gov/Services/Health-Care-Services/Lists/DepartmentNews/NewsDisp.aspx?ID=15&ContentTypeId=0x010014B81341F131154D8F418A978CE79538

  Flea-borne typhus (also called murine typhus) is a disease that can spread to people from infected fleas and their feces. People get sick with flea-borne typhus when infected flea feces are rubbed into cuts or scrapes in the skin or rubbed into the eyes. Typhus is not spread from person to person. Typhus infects the fleas of rats, cats, dogs and opossums. Infected animals dont usually show signs that theyre sick. […] Many people with typhus may have: Fever and chills Body aches and muscle pain Loss of appetite, nausea or vomiting Rash on the chest, back, arms, or legs If you have these symptoms, call your doctor. Typhus can be treated with antibiotics. Signs of typhus can start 6 to 14 days after having contact with the infected flea. […] Reduce your risk of getting murine typhus by avoiding contact with fleas. Keep fleas off your pets. Animals that are allowed outside are more likely to bring fleas inside. Talk to your veterinarian about flea control products for pets, such as flea collars, oral medication, or topical flea prevention products. Keep rodents and wild animals (e.g., opossums) away from your home, workplace, and recreational areas. Store food, including pet food, in tightly sealed containers. Remove brush, rock piles, junk, and clutter outside of your home. Seal up holes in your home where rodents can enter. Keep lids closed on compost and trashcans to discourage animal visitors. Protect yourself from flea bites. Do not feed or pet wild or stray animals. Always wear gloves if you are handling sick or dead animals. Use Environmental Protection Agency-registered insect repellents on your skin and clothing when spending time outside. Always follow instructions listed on the product label as some products are for skin and others are for clothing only.

• #26 IAMAT | Epidemic Typhus

  https://www.iamat.org/risks/epidemic-typhus

  Epidemic Typhus, also known as Epidemic Louse-borne Typhus, is caused by Rickettsia prowazekii bacteria transmitted through the bite of infected lice. A person becomes ill when contaminated lice are rubbed or crushed into the bite wound. […] The infection occurs in mountainous regions of North America, South America, central and eastern Africa, and Asia. Humanitarian workers, missionaries, and military personnel working in crowded areas under poor hygienic conditions are at greater risk. Epidemic Typhus is often present among people living in overcrowded conditions with poor sanitation and outbreaks typically occur during the colder months of the year. […] Treatment includes antibiotics and supportive care of symptoms. […] Freedom from louse infestation is the most effective protection against typhus. […] There is no preventive medication or a commercially available vaccine against Epidemic Typhus.

• #27 Typhus on The Eastern Front

  https://www.kumc.edu/school-of-medicine/academics/departments/history-and-philosophy-of-medicine/archives/wwi/essays/medicine/typhus-on-the-eastern-front.html

  Delousing soldiers was a well-organized sanitary ritual. […] For the American army, every base hospital had a routine of stripping each soldier of his uniform before admission, giving him a shower or bath with strong soap and a variety of 'cootie oils’, and then clothing him in fresh pajamas, slippers, and a robe. […] Because typhus and all of the other rickettsial diseases are easily cured with currently available antibiotics, typhus has lost its importance as a public health problem associated with warfare.

• #27 Typhus on The Eastern Front

  https://www.kumc.edu/school-of-medicine/academics/departments/history-and-philosophy-of-medicine/archives/wwi/essays/medicine/typhus-on-the-eastern-front.html

  Typhus, an infectious disease, distinct from typhoid fever, has been endemic and occasionally epidemic in Eastern Europe since time immemorial, and often associated with war. From 1918 to 1922 it swept from Serbia through Russia and surrounding countries – the Eastern Front of The Great War – causing an estimated 30,000,000 cases and 3,000,000 deaths. […] Epidemic typhus is caused by a small bacteria, a member of the rickettsia family, with the scientific name of Rickettsia prowazekii. […] The epidemic started on the Eastern Front in 1914 and 1915. […] Because of this typhus epidemic the Germans, the Austrians, and the Russians feared to invade Serbia, though it was an important military prize, a crossroads of Central and Eastern Europe, as it were. […] Did the louse change the course of The War? Yes, it basically shut down The Eastern Front.

• #28

  https://www.jidc.org/index.php/journal/article/view/30943177

  Scrub typhus is endemic in rural Southeast Asia. The district of Umphang in northwestern Thailand is a prototype environment for this disease. […] Patients diagnosed with scrub typhus between 2011 and 2014 were analyzed. Diagnosis was based on clinical symptoms in conjunction with a positive rapid test or a pathognomonic eschar lesion. […] The most common symptom was fever (93.8%), followed by headache (48.1%) and cough (33.1%). Eschars were reported in 129 patients, with a significantly higher percentage in children (p 0.001), and a different anatomical distribution was found when adults and children were compared. […] Most patients recovered from the disease. […] Scrub typhus in Umphang district is common. Patients can present with a variety of clinical symptoms, regardless of the presence of fever. Standard treatment led to a favorable outcome in most patients.

• #29 Thieme E-Journals – Journal of Pediatric Infectious Diseases / Abstract

  https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0037-1599834

  BackgroundThe aim of this study was to describe the clinical profile and atypical presentations of scrub typhus in children aged younger than 12 years admitted to a tertiary care center in south India. […] ResultsThe majority of the cases was from urban areas and presented with gastrointestinal manifestations (25/31). Eschar was noted in 23 children (74%) and was typically found above the level of the umbilicus. All cases showed a rapid resolution with doxycycline. Atypical presentations included massive lung consolidation, epididymo-orchitis, secondary hemophagocytic lymphohistiocytosis, and Kawasaki-like disease. Infants in the group presented with low to moderate grade fever, significant hepatosplenomegaly, high C-reactive protein, and leukocytosis with lymphocytic preponderance. We propose that this tetrad of features, even in the absence of an eschar, should point to a possible diagnosis of scrub typhus in infants. […] ConclusionChanges in typical presentation of pediatric scrub typhus present a continuing diagnostic challenge.

• #30 Scrub Typhus: Two Cases Presenting as Abdominal Pain

  https://www.patientcareonline.com/view/scrub-typhus-two-cases-presenting-abdominal-pain

  Scrub typhus, which is caused by Orientia tsutsugamushi, has various systemic manifestations, including GI symptoms. We describe one patient with scrub typhus who presented with symptoms that suggested acute appendicitis and another who presented with symptoms of acute cholecystitis. […] Therefore, the clinical conditions related to acute surgical abdomen in patients with scrub typhus should be differentiated carefully to avoid unnecessary surgery. […] More than one-third of patients with scrub typhus present with GI symptoms, such as nausea, vomiting, diarrhea, and abdominal pain, although there are limited precise descriptions of these presentations. […] In our cases, acute appendicitis and acute cholecystitis were suspected on the basis of the physical examination findings. […] Both of our patients presented with high fever, rash, and abdominal pain. One patient underwent surgery for clinically suspected acute surgical abdomen; however, her symptoms did not improve until after she was treated with azithromycin and doxycycline. The other patient’s symptoms improved after she was given doxycycline.

• #30 Scrub Typhus: Two Cases Presenting as Abdominal Pain

  https://www.patientcareonline.com/view/scrub-typhus-two-cases-presenting-abdominal-pain

  In summary, in patients with suspected scrub typhus who present with fever, maculopapular rash, lymphadenopathy, and eschars and whose clinical findings of acute abdomen may require surgical treatment, the symptoms might be successfully managed with appropriate medical treatment and close observation without any unnecessary surgery.

• #31

  https://www.healio.com/news/pediatrics/20190325/treatment-delays-common-among-children-with-scrub-typhus

  Many children in northern Thailand who were infected with scrub typhus were not treated in a timely manner with appropriate antibiotics, according to research published in the Journal of the Pediatric Infectious Diseases Society. Researchers warned that delays in treatment can be potentially fatal. […] The researchers said only four (11%) patients received appropriate antibiotic treatment for scrub typhus before admission. […] As a consequence, effective treatment was delayed in many patients, which might have contributed to the high complication and treatment failure rates in our study. […] Delay in an appropriate antibiotic results in progressive severity and prolonged disease.

• #32 Analysis of Health-Care Charges in Murine Typhus: Need for Improved Clinical Recognition and Diagnostics for Acute Disease in: The American Journal of Tropical Medicine and Hygiene Volume 98 Issue 6 (2018)

  https://www.ajtmh.org/view/journals/tpmd/98/6/article-p1594.xml

  Murine typhus, caused by Rickettsia typhi, is an undifferentiated febrile illness with no available rapid and sensitive diagnostic assay for use during early disease. […] These results highlight the need for improved clinical recognition and diagnostics for acute rickettsioses such as murine typhus.

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