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Background: After a 12-year absence, epidemic typhus has re-emerged among the displaced population of Burundi. Following the outbreak of civil war in 1993, over 760000 people now inhabit refugee camps, under appalling conditions. A typhus outbreak occurred among prisoners in a jail in N'Gozi in 1995. At the time, the disease was not recognised, and was referred to as sutama. Reports of sutama among the civilian population date back to late 1995 and, in association with body-louse infestation, the disease has subsequently swept across the higher and colder regions of the country.Methods: During a field study in February, 1997, 102 refugees with sutama underwent clinical examination and interview. Serum samples were collected and infesting body lice removed. Microbiological analysis included antibody estimations and specific PCRs aimed at diagnosis of Rickettsia prowezekii, Bartonella quintana, and Borrelia recurrentis. Between January and September, 1997, nationwide epidemiological data on the prevalence and distribution of sutama was obtained through liaison with local health services. A second field study in March, 1997, entailed the collection of further serum samples from suspected cases of sutama in different regions of Burundi.Findings: Most of the 102 patients with sutama during initial assessment presented with manifestations similar to those previously described for typhus in Africa, though skin eruptions occurred in only 25 (25%) cases. Microbiological testing revealed evidence of R prowazeki infection in 76 (75%) patients, confirming that most cases of clinically-diagnosed sutama were epidemic typhus, and supporting the reliability of clinical diagnosis as a basis for the nationwide surveillance of the disease. Up to September, 1997, 45558 typhus cases were clinically diagnosed, most of which occurred in regions at an altitude of over 1500 m. Serological testing of 232 individuals from different regions of Burundi provided microbiological evidence to support clinical diagnoses in seven provinces, confirming the widespread nature of the outbreak. Serum from 13 of the original 102 patients and 19 (8%) of the 232 suspected cases had raised antibody titres against B quintana. A fatality rate of 15% among jail inmates fell to 0.5% after administration of a single dose of 200 mg doxycycline to suspected cases.Interpretation: A gigantic outbreak of R prowazekii-induced typhus and B quintana-induced trench fever is continuing in Burundi. Transmission of both diseases to such a large number of people has followed a widespread epidemic of body-louse infestation. Diagnosis of typhus could be reliably made by means of clinical criteria, and the disease could be efficiently and easily treated by antibiotics. This epidemic highlights the appalling conditions in central-African refugee camps and the failure of public-health programmes to serve their inhabitants. Louse-associated disease remains a major health threat in this and other war-torn regions of the world. [ABSTRACT FROM AUTHOR]

Discusses the history of Brill-Zinsser disease. Discovery by Nathan Brill of a typhoid-like illness with negative blood cultures; Hans Zinsser's use of epidemiological and bacteriological means to discover that Brill's disease was an imported form of typhus; Modern cases of typhus; Biographical information on Brill and Zinsser.

The article discusses the emancipation, sickness and death in the American Civil War. It mentions that more than a million former slaves became sick and tens of thousands died from camp diseases including pneumonia, typhus, and dysentery during the war. It remarks that the high rates of illness and mortality during the war resulted from a range of factors including the unsanitary conditions of army camps, polluted waterways and unburied bodies of animals and soldiers.

The risk of acquiring North Asian tick typhus (infection by Rickettsia sibirica) during travel to regions of Asia where this disease is endemic is unknown. We investigated prospectively 13 paleontologists on expedition to Mongolia. Four paleontologists had acute illness characterised by fever, rash, headache, and lymphadenopathy. All had IgM and IgG antibodies to R sibirica. Paleontologists with no illness and people who went on expeditions in other parts of the world did not have antibodies to R sibirica. Only two of the four infected persons were aware of tick bites. Travellers to regions endemic for R sibirica are at risk of contracting North Asian tick typhus even in the absence of recognised tick-bites. [ABSTRACT FROM AUTHOR]

The article predicts disease outbreaks in flood-ravaged Balkans and reports that Serbia, Bosnia and parts of Croatia are struggling to recover from massive flood on May 14-18, 2014. Topics discussed include people could be at risk for enterocolitis, typhus, hepatitis and West Nile disease. Also mentioned are overcrowding at makeshift rescue centres helping to spread intestinal infection through contact and problems with hygiene, and millions of people without access to clean drinking water.

Describes the work of Charles Jules Henry Nicolle, winner of the 1928 Nobel Prize in Physiology or Medicine. His background; His work on typhus; Observations about the cause of typhus, Rickettsia prowazekii; Inducement of typhus in a chimpanzee; His other accomplishments; His personal life.