Typhus Classification and external resources
Rash caused by Epidemic typhus.
ICD-10	A75.1
ICD-9	080-083
DiseasesDB	29240
MedlinePlus	001363
eMedicine	med/2332

Typhus is any of several similar diseases caused by louse-borne bacteria. A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly Lice (singular louse) ( order Phthiraptera) are an order of over 3000 Species of wingless Insects three of which are classified The name comes from the Greek typhos, meaning smoky or lazy, describing the state of mind of those affected with typhus. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly The causative organism Rickettsia is an obligate parasite and cannot live long outside living cells. Rickettsia is a Genus of motile, Gram-negative, non-sporeforming, highly Pleomorphic bacteria that can present Parasitism is a type of symbiotic relationship between Organisms of different Species. Rickettsia is endemic in rodent hosts, including mice and rats, and spreads to humans through mites, fleas and body lice. The arthropod vector flourishes under conditions of poor hygiene, such as those found in prisons, concentration camps, or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field. Arthropods are Animals belonging to the Phylum Arthropoda (from Greek ἄρθρον arthron, " Joint " In Epidemiology, a vector is an Organism that does not cause Disease itself but which transmits Infection by conveying Pathogens from In tropical countries, typhus is often mistaken for dengue fever. The Tropics are centered on the Equator and limited in Latitude by the Tropic of Cancer in the northern hemisphere at approximately 23°26' (23

Most rickettsial diseases include the word "typhus" in their description, however related diseases include Rocky Mountain spotted fever and "spotted fevers" endemic in Colombia and Brazil. Rocky Mountain spotted fever is the most severe and most frequently reported Rickettsial illness in the United States.

Types of typhus

Epidemic typhus

Epidemic typhus (also called "Jail Fever", "Hospital Fever", "Ship fever", "Famine fever", "Petechial Fever", and "louse-borne typhus")^[1] is so named because the disease often causes epidemics following wars and natural disasters. The causative organism is Rickettsia prowazekii, transmitted by the human body louse (Pediculus humanus corporis). Rickettsia prowazekii is a species of Gram negative, rod shaped Aerobic Bacteria that is the etiologic agent of epidemic Typhus The body louse ( Pediculus humanus humanus, sometimes called Pediculus humanus corporis) is a Louse which infests humans ^[2][3] Feeding on a human who carries the bacillus infects the louse. R. prowazekii grows in the louse's gut and is excreted in its feces. Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus The disease is then transmitted to an uninfected human who scratches the louse bite (which itches) and rubs the feces into the wound. The incubation period is one to two weeks. Incubation period is the Time elapsed between exposure to a Pathogenic Organism, or Chemical or radiation, and when Symptoms R. prowazekii can remain viable and virulent in the dried louse feces for many days. Typhus will eventually kill the louse, though the disease will remain viable for many weeks in the dead louse.

Symptoms include severe headache, a sustained high fever, cough, rash, severe muscle pain, chills, falling blood pressure, stupor, sensitivity to light, and delirium. A rash is a change of the Skin which affects its color appearance or Texture. Myalgia means " Muscle Pain " and is a symptom of many diseases and disorders Rigor is a shaking occurring during a high Fever. It occurs because cytokines and Prostaglandins are released as part of an Immune Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Stupor is the lack of critical cognitive function and Level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain Photophobia is a Symptom of excessive sensitivity to Light and the aversion to Sunlight or well-lit places Delirium is an acute and relatively sudden (developing over hours to days decline in attention-focus perception and Cognition. A rash begins on the chest about five days after the fever appears, and spreads to the trunk and extremities but does not reach the palms and soles. A symptom common to all forms of typhus is a fever which may reach 39°C (102°F).

The infection is treated with antibiotics. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Intravenous fluids and oxygen may be needed to stabilize the patient. Oxygen (from the Greek roots ὀξύς (oxys (acid literally "sharp" from the taste of acids and -γενής (-genēs (producer literally begetteris the The mortality rate is 10% to 60%, but is vastly lower if antibiotics such as tetracycline are used early. This article deals with the specific antibiotic called tetracycline Infection can also be prevented via vaccination. Brill-Zinsser disease is a mild form of epidemic typhus which recurs in someone after a long period of latency (similar to the relationship between chickenpox and shingles). Chickenpox is a highly contagious illness caused by primary infection with Varicella zoster virus (VZV Herpes zoster (or simply zoster) commonly known as shingles, is a Viral disease characterized by a painful skin rash with Blisters in a limited This type of recurrence can also occur in immunosuppressed patients. Immunosuppression involves an act that reduces the activation or Efficacy of the Immune system.

Epidemic typhus is found most frequently during times of war and privation. For example, typhus killed many thousands of prisoners in Nazi Germany concentration camps during World War II. Nazi Germany and the Third Reich are the common English names for Germany under the regime of Adolf Hitler and the National Socialist German Workers Internment is the imprisonment or confinement of people commonly in large groups without trial World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including The abysmally low standards of hygiene enforced in camps such as Theresienstadt and Bergen-Belsen created conditions where diseases such as typhus flourished. Theresienstadt concentration camp (often referred to as Terezín) was a Nazi Concentration camp during World War II. Belsen redirects here For other meanings see Belsen (disambiguation. A possible modern scenario for typhus epidemics would be in refugee camps during a major famine or natural disaster. This form of typhus is also known as "prison fever" or "ship fever", because it becomes prevalent in crowded conditions in prisons and aboard ships.

Endemic typhus

Endemic typhus (also called "flea-borne typhus" and "murine typhus" or "rat flea typhus") is caused by the bacteria Rickettsia typhi, and is transmitted by the fleas that infest rats. Flea is the Common name for any of the small wingless Insects of the order Siphonaptera (some authorities use the name Aphaniptera Rats are various medium sized long-tailed Rodents of the superfamily Muroidea ^[4] Less often, endemic typhus is caused by Rickettsia felis and transmitted by fleas carried by cats or opossums. Didelphimorphia is the order of common opossums of the Western Hemisphere. Symptoms of endemic typhus include headache, fever, chills, myalgia, nausea, vomiting, and cough. Myalgia means " Muscle Pain " and is a symptom of many diseases and disorders Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Endemic typhus is highly treatable with antibiotics. ^[4] Most people recover fully, but death may occur in the elderly, severely disabled or patients with a depressed immune system.

Scrub typhus

Scrub typhus (also called "chigger-borne typhus") is caused by Orientia tsutsugamushi and transmitted by chiggers, which are found in areas of heavy scrub vegetation. Scrub typhus is a form of Typhus caused by Orientia tsutsugamushi. Orientia is a Genus of Bacteria in family Rickettsiaceae. They are Obligate Intracellular gram negative Harvest mite (genus Trombicula; also known as red bugs, trombiculid mites, scrub-itch mites, berry bugs or This variety of typhus was known in Japan as tsutsugamushi disease, hence the formal name, and was also prevalent in Malaysia and Australia. For the biogeographical region see Malesia Malaysia (məˈleɪʒə or /məˈleɪziə/ is a country that consists of thirteen states and For a topic outline on this subject see List of basic Australia topics. According to J. R. Audy, severe epidemics of the disease occurred among troops in what was then known as Burma and Ceylon during the World War II. Burma, officially the Union of Myanmar ( pjìdàunzṵ mjàmmà nàinŋàndɔ̀ is the largest country by geographical area in mainland Southeast Asia. Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka ( Sinhalese:, இலங்கை known as Ceylon before 1972 is an Island World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including Symptoms include fever, headache, muscle pain, cough, and gastrointestinal symptoms. More virulent strains of O. tsutsugamushi can cause hemorrhaging and intravascular coagulation. Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from Disseminated intravascular coagulation ( DIC) also known as consumptive coagulopathy, is a pathological activation of Coagulation (blood clotting mechanisms Contact with species related to the chigger mite, found in many parts of the world, can also cause an intense irritation of the human skin.

Vaccine

The first major step in the development of the vaccine was Charles Nicolle's 1909 discovery that lice were the vectors for epidemic typhus. A vaccine is a biological preparation which is used to establish or improve immunity to a particular disease Charles Jules Henry Nicolle ( September 21, 1866 Rouen - February 28, 1936) was a French Bacteriologist who received Lice (singular louse) ( order Phthiraptera) are an order of over 3000 Species of wingless Insects three of which are classified In Epidemiology, a vector is an Organism that does not cause Disease itself but which transmits Infection by conveying Pathogens from This made it possible to isolate the bacteria causing the disease and develop a vaccine; he was awarded the 1928 Nobel Prize in Physiology or Medicine for this work. The Nobel Prize in Physiology or Medicine (Nobelpriset i fysiologi eller medicin is awarded once a year by the Swedish Karolinska Institute. Nicolle attempted a vaccine but was not successful in making one that worked on a large enough scale. ^[5]

Henrique da Rocha Lima in 1916 then proved that the bacteria Rickettsia prowazekii was the agent responsible for typhus; he named bacteria after H. T. Ricketts and Stanislaus von Prowazek, two zoologists who died investigating a typhus epidemic in a prison camp in 1915. Henrique da Rocha Lima (1879–1956 was a Brazilian Physician, Pathologist and Infectologist. Howard Taylor Ricketts (1871-1910 was an American pathologist after whom the Rickettsiaceae family and the Rickettsiales are named Stanislaus von Prowazek (12 November 1875 Jindřichův Hradec, Bohemia - 17 February 1915 Cottbus) born Stanislav Provázek, was a Czech Zoologist Once these crucial facts were recognized, Rudolf Weigl in 1930 was able to fashion a practical and effective vaccine production method by grinding up the insides of infected lice that had been drinking blood. Professor Rudolf Stefan Weigl (1883 - 1957 was a famous Polish Biologist and inventor of the first effective Vaccine for Epidemic typhus. It was, however, very dangerous to produce, and carried a high likelihood of infection to those who were working on it.

A safer mass-production-ready method using egg yolks was developed by Herald R. Cox in 1938. Mass production (also called flow production, repetitive flow production, series production, or serial production) is the production of An egg yolk is the part of an egg which serves as the Food source for the developing Embryo inside Herald Reah Cox (1907 -1986 was an American Bacteriologist. Born in Terre Haute, Indiana, he graduated from Indiana State Normal School now ^[6] This vaccine was widely available and used extensively by 1943.

History

Civilian Public Service worker distributes rat poison for typhus control in Gulfport, Mississippi, ca. The Civilian Public Service ( CPS) provided Conscientious objectors in the United States an alternative to military service during World War II Gulfport is the second largest city in Mississippi after the state capital Jackson. 1945.

The first description of typhus was probably given in 1083 at a convent near Salerno, Italy. Salerno is a town in southern Italy, capital of the province of the same name in the region of Campania. Italy (Italia officially the Italian Republic, (Repubblica Italiana is located on the Italian Peninsula in Southern Europe, and on the two largest ^[7] In 1546, Girolamo Fracastoro, a Florentine physician, described typhus in his famous treatise on viruses and contagion, De Contagione et Contagiosis Morbis. Girolamo Fracastoro ( Fracastorius) (1478‑ August 8, 1553) was an Italian Physician, Scholar (in Mathematics Florence ( Italian: Firenze Florentia and Fiorenza) is the Capital City of the Italian region of Tuscany ^[8]

Before a vaccine was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of epidemics throughout history. In Epidemiology, an epidemic (from Greek epi- upon + demos people is a classification of a disease that appears as new cases in a ^[9] These epidemics tend to follow wars, famine, and other conditions that result in mass casualties. War is an international relations Dispute, characterized by organized Violence between National Military units A famine is a widespread shortage of food that may apply to any Faunal species which phenomenon is usually accompanied by regional Malnutrition, Starvation

During the second year of the Peloponnesian War (430 BC), the city-state of Athens in ancient Greece was hit by a devastating epidemic, known as the Plague of Athens, which killed, among others, Pericles and his two elder sons. Events By place Greece The army of Sparta loots Attica for a second time but Pericles is not daunted and refuses A city-state is a Region controlled exclusively by a City, usually having Sovereignty. The History of Athens is one of the longest of any city in Europe and in the world Greece (Ελλάδα transliterated: Elláda, historically, Ellás,) officially the Hellenic Republic (Ελληνική Δημοκρατία The Plague of Athens was a devastating Epidemic which hit the City-state of Athens in ancient Greece during the second year of the Peloponnesian Pericles (also spelled Perikles) (c 495 – 429 BC Greek:, meaning "surrounded by glory" was a prominent and influential Statesman, orator The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Epidemic typhus is a strong candidate for the cause of this disease outbreak, supported by both medical and scholarly opinions. ^[10][11]

Typhus also arrived in Europe with soldiers who had been fighting on the isle of Cyprus. Cyprus (Κύπρος transliterated: Kýpros,; Kıbrıs officially the Republic of Cyprus (Κυπριακή Δημοκρατία Kypriakī́ Dīmokratía The first reliable description of the disease appears during the Spanish siege of Moorish Granada in 1489. The description Moors has referred to several historic and modern populations of Muslim (and earlier non-Muslim people of Berber and Arab descent Granada is a city and the capital of the province of Granada, in the autonomous region of Andalusia, Spain. These accounts include descriptions of fever and red spots over arms, back and chest, progressing to delirium, gangrenous sores, and the stink of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action but an additional 17,000 died of typhus.

Typhus was also common in prisons (and in crowded conditions where lice spreads easily), where it was known as Gaol fever or Jail fever. Gaol fever often occurs when prisoners are frequently huddled together in dark, filthy rooms. Imprisonment until the next term of court was often equivalent to a death sentence. It was so infectious that prisoners brought before the court sometimes infected the court itself. Following the Assize held at Oxford in 1577, later deemed the Black Assize, over 300 died from Epidemic typhus, including Sir Robert Bell Lord Chief Baron of the Exchequer. Oxford is currently bidding for the 2010 Wikimania Conference Oxford () is a city, and the County town of Oxfordshire, The Black Assize was a plague of Epidemic typhus that struck the town of Oxford in England on July 6, 1577. Typhus is any of several similar diseases caused by Louse -borne bacteria Sir Robert Bell (Unknown &mdash d 1577 of Beaupre Hall, Norfolk, was a Speaker of the House of Commons (1572-1576 who served during the The outbreak that followed, between 1577 to 1579, killed about 10% of the English population. The English people (from the adjective in Englisc) are a Nation and Ethnic group native to England who predominantly speak English During the Lent Assize Court held at Taunton (1730) typhus caused the death of the Lord Chief Baron, as well as the High Sheriff, the sergeant, and hundreds of others. The Court of Assize, or Assizes, is a medieval term for Legal codes (such as Assizes of Jerusalem) that continues to be used in modern times Taunton is the County town of Somerset, England. The Unparished area (or former Municipal borough) of Taunton has a Population Lord Chief Baron of the Exchequer was the first "baron" ( i This is a list of High Sheriffs of Somerset. c1200 William Brewer c1400 John Delamare 1485 Amyas Paulet 1515-16 During a time when there were 241 capital offenses--more prisoners died from 'gaol fever' than were put to death by all the public executioners in the realm. In 1759 an English authority estimated that each year a fourth of the prisoners had died from Gaol fever. ^[12] In London, typhus frequently broke out among the ill-kept prisoners of Newgate Gaol and then moved into the general city population. London ( ˈlʌndən is the capital and largest urban area in the United Kingdom. For the prison in East Granby, Connecticut, see Old Newgate Prison.

A U. S. soldier is demonstrating DDT-hand spraying equipment. DDT was used to control the spread of typhus-carrying lice.

Epidemics occurred throughout Europe from the 16th to the 19th centuries, and occurred during the English Civil War, the Thirty Years' War and the Napoleonic Wars. The English Civil War (1642-1651 was a series of armed conflicts and political machinations between Parliamentarians and Royalists. For the Mauritanian Thirty Years' War see Char Bouba war. For the band see The 30 Years War. The Napoleonic Wars (1803-1815 involved Napoleon's French Empire and a shifting set of European allies and opposing coalitions During Napoleon's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians. Napoleon Bonaparte (15 August 1769 – 5 May 1821 was a French military and political leader who had a significant impact on the History of Europe. Moscow (Москва́ romanised: Moskvá, IPA: see also other names) is the Capital and the largest city of This article is about the country For a topic outline on this subject see List of basic France topics. Russia (Россия Rossiya) or the Russian Federation ( Rossiyskaya Federatsiya) is a transcontinental Country extending A major epidemic occurred in Ireland between 1816-19, and again in the late 1830s, and yet another major typhus epidemic occurred during the Great Irish Famine between 1846 and 1849. Ireland (pronounced /ˈaɾlənd/ Éire) is the third largest island in Europe, and the twentieth-largest island in the world The Irish typhus spread to England, where it was sometimes called "Irish fever" and was noted for its virulence. It killed people of all social classes, since lice were endemic and inescapable, but it hit particularly hard in the lower or "unwashed" social strata.

In America, a typhus epidemic killed the son of Franklin Pierce in Concord, New Hampshire in 1843 and struck in Philadelphia in 1837. Franklin Pierce (November 23 1804 &ndash October 8 1869 was an American politician and the fourteenth President of the United States, serving from 1853 to The city of Concord (ˈkɒnkərd often mispronounced as " Concorde " is the Capital of the state of New Hampshire in the United States Philadelphia (ˌfɪləˈdɛlfiə Several epidemics occurred in Baltimore, Memphis and Washington DC between 1865 and 1873. Memphis is a City in the southwest corner of Tennessee, and the County seat of Shelby County. Washington DC ( formally the District of Columbia and commonly referred to as Washington, the District, or simply D Typhus fever was also a significant killer during the US Civil War, although typhoid fever was the more prevalent cause of US Civil War "camp fever". Typhoid fever, also known as enteric fever, bilious fever, Yellow Jack or commonly just typhoid, is an illness caused by the Bacterium Typhoid is a completely different disease from typhus.

During World War I typhus caused three million deaths in Russia and more in Poland and Romania. World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All Poland (Polska officially the Republic of Poland Romania ( dated: Rumania, Roumania De-lousing stations were established for troops on the Western front but the disease ravaged the armies of the Eastern front, with over 150,000 dying in Serbia alone. Fatalities were generally between 10 to 40 percent of those infected, and the disease was a major cause of death for those nursing the sick. Some historians assert that the disease may serve as a model for the use of biological weapons while in the field. Between 1918 and 1922 typhus caused at least 3 million deaths out of 20–30 million cases. In Russia after World War I, during a civil war between the White and Red armies, typhus killed three million, largely civilians. The White movement (Beloie Dvijenie Белое движение whose military arm is known as the White Army (Belaia Armia Белая Армия or White Guard The Red Army ( Russian: Рабоче-Крестьянская Красная Армия R aboche- K rest'yanskaya K rasnaya A rmiya Even larger epidemics in the post-war chaos of Europe were only averted by the widespread use of the newly discovered DDT to kill the lice on millions of refugees and displaced persons. DDT (from its trivial name D ichloro- D iphenyl- T richloroethane is one of the best known synthetic Pesticides It is a chemical with a long

During World War II typhus struck the German army as it invaded Russia in 1941. The German Army (Deutsches Heer heɐ) is the land component of the armed forces of the Federal Republic of Germany. ^[6] In 1942 and 1943 typhus hit French North Africa, Egypt and Iran particularly hard. France was a dominant empire in the world from the 1600s to the late 1960s possessing many colonies in various locations around the world This article is about the country of Egypt For a topic outline on this subject see List of basic Egypt topics. For a topic outline on this subject see List of basic Iran topics. ^[13] Typhus epidemics killed inmates in the Nazi Germany concentration camps; infamous pictures of typhus victims' mass graves can be seen in footage shot at Bergen-Belsen concentration camp. ^[6] Thousands of prisoners held in appalling conditions in Nazi concentration camps such Theresienstadt and Bergen-Belsen also died of typhus during World War II^[6], including Anne Frank at the age of 15 and her sister Margot. Nazism, which was a short name for National Socialism (Nationalsozialismus refers primarily to the Ideology and practices of the National Socialist German Annelies Marie "Anne" Frank ( (12 June 1929 – early March 1945 was a Jewish girl born in the city of Frankfurt am Main in Weimar Germany

Following the development of a vaccine during World War II, epidemics usually occurred in Eastern Europe, the Middle East and parts of Africa. Eastern Europe is a general term that refers to the Geopolitical region encompassing the easternmost part of the European continent. The Middle East is a Subcontinent with no clear boundaries often used as a synonym to Near East, in opposition to Far East.

Cultural references

• (1847) In Jane Eyre by Charlotte Brontë, an outbreak of typhus occurs in Jane's school Lowood, highlighting the unsanitary conditions the girls live in. Jane Eyre (dʒeɪn ɛə by Charlotte Brontë, published by Smith Elder & Company of London in 1847, is one of the most influential and Charlotte Brontë (ˈbrɒnti (21 April 1816 &ndash 31 March 1855 was a British Novelist, the eldest of the three famous Brontë sisters whose Novels

• (1862) In Fathers and Sons by Ivan Turgenev, Evgeny Bazarov dissects a local peasant and dies due to contracting typhus. Fathers and Sons is a 1862 Novel by Ivan Turgenev, his best known work Ivan Sergeyevich Turgenev ( ɪˈvan sʲɪrˈgʲeɪvʲɪtɕ turˈgʲenʲɪf ( &ndash) was a Russian novelist and playwright

• (1886) In the short story Excellent People by Anton Chekhov, typhus kills a Russian provincial. The short story is a literary genre of Fictional Prose Narrative that tends to be more concise and to the point than longer works of fiction such Anton Pavlovich Chekhov ( –) (Анто́н Па́влович Че́хов) was a Russian short-story writer and Playwright, considered to be one Russia (Россия Rossiya) or the Russian Federation ( Rossiyskaya Federatsiya) is a transcontinental Country extending

• (1890) In How the Other Half Lives by Jacob Riis, the effects of typhus fever and small-pox on "Jewtown" are described. How the Other Half Lives Studies Among the Tenements of New York (1890 was a pioneering work of Photojournalism by Jacob Riis, documenting the squalid Jacob August Riis (May 3 1849 - May 26 1914 a Danish -American Muckraker Journalist, Photographer, and social reformer was born in

• (1955) In Vladimir Nabokov 's Lolita, Humbert Humbert's childhood sweetheart, Annabel Leigh, dies of typhus. This page is about the novelist For his father the politician see Vladimir Dmitrievich Nabokov. Lolita (1955 is a Novel by Vladimir Nabokov, first written in English and published in 1955 in Paris, later translated by the author

• (c. 1974) In Little House on the Prairie (TV series), an outbreak of typhus hits Walnut Grove killing several. Little House on the Prairie is a children's book by Laura Ingalls Wilder that was published in 1935 Walnut Grove is the name of many communities in the US and Canada, including Walnut Grove Alabama Walnut Grove Arizona It is traced to below market cost corn meal residents had been purchasing to avoid the high cost of the local mill. Cornmeal is Flour ground from dried corn, and is a common Staple food. The corn meal had been infested by rats.

• (1978) O'Brian, Patrick. Patrick O'Brian, CBE ( 12 December 1914 &ndash 2 January 2000; born as Richard Patrick Russ) was an English Desolation Island Fictional presentation of typhus - while sailing aboard the Leopard an outbreak of 'gaol-fever' strikes the crew.

References

• Audy, J. R. "Red Mites and Typhus. " London: The Athlone Press. 1968. ISBN 0485263181
• May, Jacques M. "Maps of the World - Distribution of Rickettsial Diseases. " Geographical Review, Vol. 44, No. 1 (January, 1954) pp. 133-136.