Typhus

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Classification according to ICD-10
A75 Typhus
ICD-10 online (WHO version 2019)
Epidemic typhus Burundi.jpg

Typhus , also typhus , typhoid exanthemicus , Kriegspest , lice fever , shipping fever , hospital fever or septic fever is an infection with micro-organisms ( bacteria ) of the genus Rickettsia ( Rickettsia prowazekii or Rickettsia prowazeki ) obtained by lice , especially the body louse is transmitted. Proof of the pathogen is required in Germany and the disease in Austria.

The term typhus is derived from the characteristic fever that occurs and a symptom of the disease, a red-spotted skin rash that can affect the face (“typhus face”) and extremities, among other things.

In addition to the classic epidemic spotted fever and Mediterranean spotted fever (pathogen: Rickettsia conorii), there are diseases (rickettioses) caused by other rickettsiae (e.g. from the tick spotted fever group), also called “spotted fever”, caused by mites , ticks or fleas (Flea spotted fever, Murine spotted fever) can be transmitted.

Confusion with typhoid

Previously spotted fever was also known as epidemic typhus , because of occurring rash as typhoid exanthemicus referred as well as typhoid mildest , typhoid ambulatorius , typhoid carcerum , famine fever , war fever and typhoid bellicus , as it is sometimes epidemic spread under poor hygienic conditions in wartime and the symptoms of typhoid and typhus are similar. Typhus is not to be equated with the disease (in German usage) called typhus , which is caused by salmonella . Without knowing the potential pathogen, solely on the basis of the clinical symptoms, William Jenner pleaded as early as 1849 to differentiate between typhus, typhoid and relapse fever. Previously, typhus was also known as typhus. In international use, such as B. in English, the disease described here is referred to as typhus or sometimes as typhus fever . The disease caused by Salmonella is internationally known as typhoid fever .

course

In addition to direct infection via live lice, the infection can also occur via dried lice carcasses and lice excrement, which are still infectious for several months. The incubation period is 10-14 days. This can lead to a prodromal stage with chills, increasingly high fever, headache and body aches and clouding of consciousness (if the brain is also affected). Later, a blue to red blotchy rash caused by petechial hemorrhages is typical.

Characteristic of the course of the fever is a two- to three-day increase in temperature (stage incrementi), followed by a continuous fever of about ten days and subsequent defeverment over several days.

Typhus fever favors further infections by other bacteria, so-called secondary infections. These include:

Since the 1950s, the disease has mainly occurred in the subtropics and tropics . A possible second infection runs due to the active immunization with weakened symptoms.

Diagnosis

The diagnosis can be made clinically or serologically. The serum of a patient who has antibodies against rickettsiae cross- reacts with the pathogen Proteus OX19 (also Proteus X-19 ) and flocculates (agglutination, Weil-Felix reaction ). Ludwik Fleck developed a skin test to diagnose typhus fever.

treatment

In rickettsial infections, tetracyclines or chloramphenicol are most effective; the standard treatment is doxycycline . There are currently no typhus vaccines available.

For typhus, antibiotic treatment should start as early as possible, then it shows a good chance of recovery. The fever drops just one to two days after the start of therapy.

forecast

If left untreated, typhus can be fatal in up to 40 percent of cases. If it is treated in good time, the prognosis is good: Typically typhus heals completely and without consequences after antibiotic treatment.

Sometimes the typhus pathogens stay in the body for up to 30 years. Normally they do not trigger a new disease during this time, as they are kept in check by the body's own defense system. However, if symptoms break out, this is referred to as Brill-Zinsser disease . It is much shorter and milder than typhus.

history

Until 1938

Typhus, which probably existed in ancient times but was only reliably described in the 16th century, appeared in Europe primarily as a “typical epidemic of war and misery”. Typhus became a serious problem for Napoleon's army during the Russian campaign . The bitter winter cold forced the soldiers to wear their clothes continuously without being able to change or clean them. They also used clothing from fallen soldiers to keep themselves warm. It was therefore easy for the clothes lice infected with rickettsia to multiply and spread. When the “ Grande Armée ” , who had moved to Russia in June 1812, withdrew in the autumn of 1813, Mainz was the first stop on French soil. 15,000–17,000 men of the French occupation and just as many civilians died there. The disease, which at that time was also known as "nerve fever" because of the neurological symptoms that occurred, remained in the French language as Typhus de Mayence (after the French name for Mainz). In the Franconian area around the Grand Duchy of Würzburg , 14,000 cases of typhus were recorded by the end of October 1814, 2,500 of which were fatal. Another epidemic, with about two and a half million fatalities, occurred in Russia between 1918 and 1922 as a result of war and civil war .

Osip Osipovič Močutkovsij (1845–1903), the head of the infection department at the Odessa City Hospital , recognized that lice bites cause the disease . The pathogen was first described in 1916 by the Brazilian microbiologist Henrique da Rocha Lima (1879–1956), who worked at the Institute for Ship and Tropical Diseases in Hamburg . (He demonstrated the organisms previously seen in typhus lice by the American microbiologist Howard T. Ricketts and the Hamburg bacteriologist Stanislaus von Prowazek , who both died during their typhus research, and their reproduction in the intestines of the lice). Further research on typhus followed, among other places, at the Georg-Speyer-Haus in Frankfurt am Main.

Also during the First World War, the Polish biologist Rudolf Weigl was called up as a scientist in the medical services of the Austro-Hungarian army , where he found a typhus vaccine while researching typhus . After the end of the war, he was appointed professor of biology at Lviv University, where he continued his research and the vaccine production based on it.

Second World War

National Socialist propaganda poster from the Generalgouvernement with the inscription: "Żydzi - wszy - tyfus plamisty" ( German  "Juden - Läuse - Typhus " ), 1942

After the outbreak of World War II, typhus, also known as typhus , was used by the National Socialists to defame the Jews in the German-occupied part of Poland, the so-called Generalgouvernement . Jews were labeled the lice that would transmit the disease, and the " Jewish parasite " was an anti-Semitic stereotype . Anyone who hid a Jew, like a Jew who left the ghetto , would therefore face the death penalty because of the alleged risk of infection . In 1941, a typhus epidemic broke out in the Warsaw ghetto and subsided again after a short time.

After the German invasion of parts of eastern Poland, which had previously been occupied by the Soviet Union, and the shooting of 25 Lviv university professors on June 30, 1941, Rudolf Weigl declared himself ready to start his vaccine production as head of the local institute for typhus and virus research , an offshoot of the Kraków institute for Spotted fever and virus research by the Army High Command to continue. In the following four years he was able to count several thousand people as so-called " Lice feeders " ( Polish: "karmiciele wszy" ) save life: the job of these Weigl employees was to feed infected lice (from which the vaccine was then obtained) locked in small cages with their blood, for which they as "war important" employees They received special identification documents that protected them from the worst reprisals and also granted them higher food rations and the opportunity to move around relatively freely.

In the nearby Auschwitz concentration camp, however, something similar happened, only involuntarily: Heinrich Mückter , who later became head of research , abused Heinrich Mückter , who later became head of research, in his position as medical officer and deputy director of the Institute for Spotted Fever and Virus Research at the OKH in Krakow, which was also the administrative capital of Auschwitz Pharma company Grünenthal , some of the concentration camp prisoners there as hosts for lice infected with typhus, from which he subsequently obtained Weigl's typhus vaccine, but was able to escape his arrest after the end of the war by fleeing to the western occupation zones .

At the same time, Nazi doctors, above all Erwin-Oskar Ding-Schuler , but also human experiments on possible vaccines on prisoners etc. a. of the Buchenwald concentration camp , where several hundred people died of artificially induced infections. Similar experiments took place in the Natzweiler-Struthof concentration camp , in the Schirmeck-Vorbruck security camp and in the Bergen-Belsen concentration camp .

Shortly before the liberation, typhus epidemics broke out in several concentration camps, including in Bergen-Belsen. According to recent findings, the siblings Margot and Anne Frank also died there of typhus in February 1945.

Based on the research of Rudolf Weigl, two Polish doctors managed to simulate a typhus epidemic in two places in Poland for years. The two doctors Stanisław Matulewicz and Eugeniusz Łazowski (1913-2006) were graduates of the University of Warsaw and therefore knew Weigl's work well. At the time of the Nazi invasion in 1939, you were general practitioners in Rozwadów and Zbydniów near Stalowa Wola in what is now south-eastern Poland. By injecting suspensions with the OX-19 antigen of the Proteus mirabilis bacterium , they were able to achieve false-positive results in the Weil-Felix reaction, which was used to detect typhus. Despite controls, they were able to simulate an epidemic for several years, so that the occupiers set up a restricted zone for fear of spreading and the two doctors saved around 8,000 people according to estimates. This is worked up literarily in the novel "Night Train" by Barbara Wood .

Reporting requirement

In Germany, the direct or indirect detection of the pathogen Rickettsia prowazekii must be reported by name in accordance with Section 7 of the Infection Protection Act (IfSG) if the evidence indicates an acute infection. The obligation to notify primarily concerns the management of laboratories ( § 8 IfSG).

In Austria, rickettsiosis caused by R. prowazekii is a notifiable disease in accordance with Section 1 (1) of the 1950 Epidemic Act . The reporting obligation relates to suspected cases, illnesses and deaths. Doctors and laboratories, among others, are obliged to report this ( Section 3 Epidemics Act).

See also

literature

  • Olga Brecht: Typhus research in World War I as reflected in the German and Munich medical weekly, dissertation Institute for the History of Medicine, University of Heidelberg, supervisor Wolfgang U. Eckart , University Library Heidelberg 2008, table of contents
  • Gerhard Dobler, Roman Wölfel: Typhus and other rickettsioses: Old and new infections in Germany . In: Dtsch Arztebl Int . No. 106 (20) , 2009, pp. 348-354 ( aerzteblatt.de ).
  • Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 9-223, here: pp. 154-158 ( typhus ).

Web links

Wiktionary: typhus  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Gerhard Dobler, Roman Wölfel: Typhus and other rickettsioses: Old and new infections in Germany . In: Dtsch Arztebl Int . No. 106 (20) , 2009, pp. 348-354 ( aerzteblatt.de ). .
  2. ^ William Jenner: On the Identity or Non-identity of the specific cause of Typhoid, Typhus, and Relapsing Fever. In: Med Chir Trans. , 1850, 33, pp. 23-42.1. PMC 2104228 (free full text)
  3. ^ Joh. Claudius Renard: A contribution to the history of the contagious typhus of the years 1813 and 1814. In: Hufelands Journal 6, 1815, pp. 3–46.
  4. ↑ Typhus: MedlinePlus Medical Encyclopedia. Retrieved September 12, 2011 .
  5. ↑ International Statistical Classification of Diseases and Related Health Problems , English version
  6. ↑ John DC Bennett, Lydia Tyszczuk: Deception by immunization, revisited British Medical Journal 1990, Volume 301, Issue 22-29 . December 1990, pages 1471-1472
  7. ↑ Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. 1961, p. 156.
  8. ↑ Ludwik Fleck : Experiments on a local skin reaction with Proteus X-19 extracts (the exanthine reaction). In: Journal of Immunology Research and Experimental Therapy. Volume 72, 1931, pp. 282-300.
  9. ↑ Ludwik Fleck, I. Hescheles: About a typhus skin reaction (the exanthine reaction) and its similarity to the thickness test. In: Clinical weekly. Volume 10, 1931, p. 1075 f.
  10. ^ Gerhard Dobler, Roman Wölfel: Typhus and Other Rickettsioses. In: Deutsches Aerzteblatt Online. 2009, doi: 10.3238 / arztebl.2009.0348 .
  11. ↑ Cf. also Georg Sticker : Hippokrates: Der Volkskrankheiten first and third book (around the year 434–430 BC). Translated, introduced and explained from the Greek. Johann Ambrosius Barth, Leipzig 1923 (= Classics of Medicine. Volume 29); Unchanged reprint: Zentralantiquariat der Deutschen Demokratischen Republik, Leipzig 1968, p. 91 f., note 4 (on burning fever and relapsing fever ) and 104–106 (on typhus ) as well as p. 109, note 13, and p. 118, Note 22.
  12. ↑ Karl Wurm, AM Walter: Infectious Diseases. 1961, p. 154 f.
  13. ↑ Manfred Vasold: The typhus epidemic of 1813/14 in the Main Franconian area. In: Würzburg medical history reports. Volume 23, 2004, pp. 217-232, here: 217.
  14. ↑ Manfred Vasold: The typhus epidemic of 1813/14 in the Main Franconian area. In: Würzburg medical history reports. Volume 23, 2004, pp. 217-232, here: pp. 218-224.
  15. ^ Wilhelm Christoph Hufeland : First report on epidemic and contagious nerve fever and its treatment in the Kg. Charité hospital in Berlin. In: Hufelands Journal 1, 1813, pp. 1-40.
  16. ^ Alfred Hartmann: Typhus epidemic in Mainz and the surrounding area in the years 1813/14, called "Typhus de Mayence". Dissertation. Hygiene Institute of the City and University of Frankfurt, Frankfurt am Main 1949.
  17. ^ Anton Chroust : History of the Grand Duchy of Würzburg (1806-1814). The foreign policy of the Grand Duchy of Würzburg. Würzburg 1932, p. 442.
  18. ↑ Manfred Vasold: The typhus epidemic of 1813/14 in the Main Franconian area. In: Würzburg medical history reports. Volume 23, 2004, pp. 217–232, here: p. 230.
  19. ↑ P. Mühlens : The Russian famine and epidemic catastrophe in the years 1921-22. In: Journal for Hygiene and Infectious Diseases , 99, 1923, pp. 1-45.
  20. ↑ Joachim Stahnke: Ludwik Teichmann (1823–1895). Anatomist in Krakow. In: Würzburg medical history reports. Volume 2, 1984, pp. 205-267, here: p. 216.
  21. ↑ Horst Kremling : Historical considerations on preventive medicine. In: Würzburg medical history reports. Volume 24, 2005, pp. 222-260, here p. 231.
  22. ↑ Karl Wurm, AM Walter: Infectious Diseases. 1961, p. 155.
  23. ↑ R. Otto : On the bacteriology of spotted fever. In: Wilhelm Kolle on the 60th birthday. Works from the State Institute for Experimental Therapy and the Georg Speyer home in Frankfurt a. M., founded by Paul Ehrlich . Issue 21, Jena 1928, pp. 123-132.
  24. ↑ Jacek Andrzej Młynarczyk 1968-: Cena poświęcenia: zbrodnie na Polakach za pomoc udzielaną Żydom w rejonie Ciepielowa , Sebastian Piątkowski, Instytut Studiów Stategicznych, Kraków 2007 ISBN 978-83-8783262-9 , OCLC 313476409 .
  25. ↑ Berit Uhlmann: How the typhus epidemic disappeared from the Warsaw ghetto. Accessed July 31, 2020 .
  26. ↑ Success story with a catastrophic flaw . WDR ; November 23, 2006; accessed on July 17, 2019.
  27. ↑ gesch.med.uni-erlangen.de ( Memento of the original from October 10, 2004 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Information material from the University of Erlangen on typhus experiments in the Buchenwald concentration camp @1@ 2Template: Webachiv / IABot / www.gesch.med.uni-erlangen.de
  28. ↑ Eugen Kogon: The SS State . 25th edition. Heyne, Munich 1993, ISBN 3-453-02978-X , p. 192 and passim .
  29. ↑ The Nuremberg Trial, one hundred and ninety-ninth day of the process, morning session, Friday August 9, 1946. Volume 20, pp. 596 f.
  30. ↑ Erika Prins, Gertjan Broek: One day they just weren't there ... (PDF) Anne Frank Stichting, March 2015, accessed on March 31, 2015 .
  31. ↑ John DC Bennett, Lydia Tyszczuk: Deception by immunization, revisited British Medical Journal 1990, Volume 301, Issue 22-29 . December 1990, pages 1471-1472
  32. ↑ Art Golab: Chicago's 'Schindler' who saved 8,000 Poles from Nazis dies Chicago Sun-Times, December 20, 2006, obituary in [ttps: //web.archive.org/web/20071030214848/ http: // findarticles. com / p / articles / mi_qn4155 / is_20061220 / ai_n17079978 / pg_1 Webarchive] accessed on August 23, 2020 at 12:23 a.m. MEST