Typhus exanthematicus, Rocky Mountain fever, and the tsutsugamushi disease have been classified in the "typhus group" by Megaw, as louse-typhus, tick-typhus, and mite-typhus. He has added a fourth-class, comprising typhus-like fevers, with unknown vectors. It is the diseases of this class with which this paper is concerned. Endemic typhus (Brill's disease) is very closely related to typhus fever; the Weil-Felix reaction is positive, typhus-like vascular lesions are present, and there is cross-immunity with typhus. In the exanthematic fever of Marseilles the relationship is more superficial; there is neither cross-immunity nor vascular lesion, and the Weil-Felix reaction is negative. Some, e.g., the scrub-typhus of Malaya (vector probably a mite), are more nearly related to tsutsugamushi than to typhus; others, e.g., Indian "tick-typhus" (vector probably a tick), to Rocky Mountain fever.All are non-contagious, non-epidemic, warm-weather diseases. They are unassociated with dirt, squalor, or lice, and are restricted to definite foci. Probably rodents or other animals are the reservoirs of the virus. On the question of identity with typhus, health authorities decide that notification is unnecessary; typhus introduced into America spreads, Brill's disease does not.These typhus-like diseases are not the same in all the countries where they occur. There are two main groups: (1) an urban group, more closely related to typhus, in which the Weil-Felix reaction is positive; (2) a rural group, more closely related to tsutsugamushi and Rocky Mountain fever, in which the Weil-Felix reaction is negative. There is a special non-indologenic strain of B. proteus, which is agglutinated in some of the fevers belonging to the second group.TROPICAL TYPHUS IN THE MALAY STATES: (1) urban form, or "shop-typhus," resembling Brill's disease; (2) rural form or "scrub-typhus." Peculiar association with oil-palms and coarse grass.
A high prevalence of murine typhus was found in the human and rodent populations of Senaling, West Malaysia. In addition to 2 index cases which prompted the investigation, 45% of the humans and 35% of the rodents had IFA titers of 1/50 or greater. Serological studies provided evidence of recent infections in 3 human subjects. In a control group of Malaysian soldiers IFA titers of 1/50 or greater were found in only 13 (5%) of 265 sera tested.
1. Cross-immunity tests between strains of rural typhus and tsutsugamushi in the guinea-pig, rabbit and monkey were made. Complete cross-immunity between the strains was demonstrated.
2. The problem of the absence of a primary ulcer in rural typhus and its presence in tsutsugamushi is discussed. Experimental findings are recorded; from consideration of these and certain clinical and epidemiological observations, the conclusion is drawn that one and the same virus may cause gradations of dermal lesion that vary greatly in extent and duration.
3. Correlation of the results of cross-immunity tests and experimental infections with clinical, aetiological, epidemiological and serological findings indicates that the two diseases are identical. Rural typhus is not a disease sui generis, and the term should be discarded, the older designation, "tsutsugamushi disease ", being retained.
Part VIII.
1. Cross-immunity experiments in the guinea-pig, rabbit and monkey were carried out with the viruses of the tsutsugamushi disease (including rural typhus) and the urban typhus of Malaya; they showed that immunogenically the two viruses are distinct.
2. The characteristics of setiology, epidemiology, serology and experimental infections are compared, and the conclusion drawn that the two diseases belong to entirely separate groups of rickettsial disease.
Part IX.
1. Cross-immunity experiments in the guinea-pig and rabbit were carried out with the viruses of Rocky Mountain spotted fever, tsutsugamushi (including rural typhus) and urban typhus. They showed that, immunologically, tsutsugamushi
and spotted fever are entirely distinct; whereas urban typhus and spotted fever, though more distinct than alike immunologically, do possess a minor degree of reciprocal cross-immunity.
2. Spotted-fever vaccine was found to have no protective value against the viruses of tsutsugamushi and urban typhus.
1. Transmission of the virus of urban typhus under experimental conditions from rat to rat by the rat flea (X. cheopis) by feeding has been effected. Collateral attempts to transmit the virus of rural typhus by precisely the same procedure failed.
2. Transmission of the virus of urban typhus was also achieved by the inoculation of faeces or crushed tissue of infected fleas into the scarified skin of guinea-pigs.
3. Multiplication of the virus of urban typhus occurs within the rat flea.
4. Infection with the virus of urban typhus is not hereditary in the rat flea.
5. Attempts to transmit the virus of urban or rural typhus by two species of ticks failed. In the case of rural typhus a lessened mortality in the experimental guinea-pigs following test inoculation with passage virus makes it, however, difficult to exclude ticks entirely as a minor factor in the epidemiology of rural typhus.
Singapore is a modern urban city and endemic typhus is thought to be a disease of the past. This may be due to lack of specific serological testing as indirect immunoperoxidase testing using specific rickettsial antigens (U.S. Army Medical Research Unit, Institute of Medical Research, Kuala Lumpur, Malaysia) has only recently become available. In the last fourteen months, twenty-one cases of endemic typhus were diagnosed in patients hospitalised for acute febrile illnesses at the National University Hospital. We conducted a case control study to define the clinical and laboratory features of endemic typhus in Singapore.
Dog sera, collected from different communities throughout Selangor, Peninsular Malaysia, were investigated for the presence of antibodies to R. tsutsugamushi and R. typhi. Scrub typhus antibodies were present in animals from the rural areas only, whereas murine typhus antibodies were observed in equal numbers of dogs from both rural and metropolitan areas. Greater percentage of dogs from suburban areas had demonstrable antibody titers to murine typhus than from the urban area.
Limited information is available on the etiological agents of rickettsioses in southeast Asia. Herein, we report the molecular investigation of rickettsioses in four patients attending a teaching hospital in Malaysia. DNA of Rickettsia sp. RF2125, Rickettsia typhi, and a rickettsia closely related to Rickettsia raoultii was detected in the blood samples of the patients. Spotted fever group rickettsioses and murine typhus should be considered in the diagnosis of patients with nonspecific febrile illness in this region.
The seroprevalence of Orientia tsutsugamushi, Rickettsia typhi, and TT118 spotted fever group (SFG) rickettsiae in 300 rubber estate workers in Slim River, Malaysia was determined in December 1996 and March 1997. In December, which was the wet season, 23.3%, 3.0%, and 57.3% of the population had antibodies detected against the three rickettsiae, respectively. The highest seropositive rate of 40% was detected for single infection with SFG rickettsiae, followed by a rate of 15.3% for both O. tsutsugamushi and SFG rickettsiae among the rubber estate workers. Subjects less than 21 years old had a lower seroprevalence of SFG rickettsiae compared with the other age groups. Indians had a higher seroprevalence of O. tsutsugamushi compared with other ethnic groups. Rubber tappers had a higher seroprevalence of SFG rickettsiae compared with other occupational groups. During the dry season in March 1997, there was a significant increase in the seroprevalence of R. typhi. The seroconversion rates for IgM against O. tsutsugamushi, R. typhi, and SFG rickettsiae were 5.7%, 12.3%, and 15.1%, respectively, during the four-month period. Significant variations of antibody titers towards the three rickettsiae was noted among subjects who were bled twice. This suggests a significant and continual exposure of rubber estate workers to the three rickettsiae.
A seroepidemiological survey of 837 people and 383 febrile patients was performed in rural areas of Sabah. We determined that the rickettsial diseases scrub typhus and endemic typhus were uncommon causes of febrile illness, as was tick typhus, except in forest dwelling peoples. The rate of occurrence of SFGR specific antibody was 16.5% among 412 forest dwellers, indicating that tick typhus may be a frequent cause of illness in this population.