Rickettsia typhi as Cause of Fatal Encephalitic Typhus in Hospitalized Patients, Hamburg, Germany, 1940-1944.

We evaluated formalin-fixed paraffin-embedded tissue specimens from 7 patients who died with encephalitic typhus in Hamburg, Germany, during World War II. The archived specimens included only central nervous system tissues >70 years old that had been stored at room temperature. We demonstrated successful detection of Rickettsia typhi DNA by a nested qPCR specific to prsA in 2 patients. These results indicate that R. typhi infections contributed to typhus outbreaks during World War II. Immunohistochemical analyses of brain tissue specimens of R. typhi DNA-positive and -negative specimens showed perivascular B-cell accumulation. Around blood vessels, nodular cell accumulations consisted of CD4-positive and CD8-positive T cells and CD68-positive microglia and macrophages; neutrophils were found rarely. These findings are similar to those of previously reported R. prowazekii tissue specimen testing. Because R. typhi and R. prowazekii infections can be clinically and histopathologically similar, molecular analyses should be performed to distinguish the 2 pathogens.

A survey of scrub and murine typhus in the Ancol section of Jakarta, Indonesia.

Rickettsia tsutsugamushi was isolated from L. (L.) arenicola chiggers and three species of rats in an area of scrub and sedge along the Bay of Jakarta. This is the only finding in Indonesia of a cycle of the agent of scrub typhus associated with L. (L.) arenicola. A serologic survey of nearly 300 persons living in two kampungs near the site at which rickettsiae were recovered revealed one individual with antibodies to R. tsutsugamushi. Murine typhus, with a seropositivity rate of 6.5%, may be endemic at low levels.