Typhus is an acute febrile illness with more than one form.

It is caused by rickettsial
infection, which is endemic in many parts of the world, and is acquired via lice and
fleas from other humans and small mammals such as rats, cats and squirrels (most
commonly rats).

There are two major types: epidemic typhus, and endemic (or murine) typhus.
Epidemic typhus is the more serious condition, which has historically been
responsible for vast numbers of deaths, particuarly in times of war and hardship.
Today, if caught early and treated, it is not usually fatal.

Scrub typhus, technically a separate condition, is also described here due to its
clinical and epidemiological similarity to typhus proper.
Causative organisms

The causative rickettsial bacteria are Gram-negative coccobacilli. These are obligate
intracellullar parasites which are found in many animals including rats and mice:

Rickettsia prowazekii causes epidemic typhus, the more severe form, and is
spread mainly by lice, although sylvatic typhus (also due to R. prowazekii) is found
in the USA and associated with bites from the fleas of a flying squirrel.
Rickettsia typhi causes endemic or murine typhus and is transmitted by fleas.
The term endemic refers to the fact that there is an animal reservoir of disease
maintaining the presence of typhus in a particular area.
Rickettsia felis is found in cats and has also been linked to endemic typhus.
Recrudescent typhus (Brill-Zinsser disease) occurs when latent infection
reactivates, and is found in about 15% of cases (even where previously treated). It
may trigger new epidemics through infection of a new generation of lice.
Scrub typhus is caused by the organism Orientia tsutsugamushi, which is not
classified with the other rickettsiae. However, whilst technically classified separately
to epidemic and endemic typhus it is in presentation and treatment so closely
related as to be considered here.

The bacteria which cause endemic and epidemic typhus are not transmitted directly
by bites, but by contamination of the bite site with infected louse faeces which are

then inoculated by human excoriation. They then parasitise the endothelial cells of
blood vessels, causing a multisystem vasculitis. Orientia tsutsugamushi is
transmitted by the ovaries of trombiculid mites. The offspring infected mites are
known as chiggers, and pass the infection directly to humans.