A man hospitalized for dehydration a few months ago at Los Angeles County-USC Medical Center started suffering a severe fever, and doctors weren’t sure why.
The patient was homeless, a clue to doctors that he might have typhus. Every year people contract flea-borne typhus in Southern California, mostly in Los Angeles County. Doctors did a blood test.
“We sent it off, and lo and behold — typhus,” County-USC Chief Medical Officer Dr. Brad Spellberg said.
Since July, there have been nine cases of typhus in downtown Los Angeles, six of which infected homeless people, prompting health officials last week to declare an outbreak there. There have also been 20 cases in Pasadena this year, far more than the five typically seen there annually.
Typhus outbreaks are often associated with poor hygiene and overcrowding. Los Angeles officials say they’re corralling stray animals that could carry fleas, cleaning streets and encouraging people to treat their pets for fleas and put away trash that may attract infected animals.
The outbreak has also fueled debates about homelessness and housing. L.A. Mayor Eric Garcetti this week pledged $300,000 to increase street cleaning downtown. But many fear that won’t be enough to curb the growing number of cases and clear out the trash that has accumulated as the city’s homeless population has spread.
“The sidewalks weren’t ever intended for habitation, our storm drains were never intended for human waste, and rats [are] crawling all over people,” said Estela Lopez, executive director of the L.A. Downtown Industrial Business Improvement District. “This is unimaginable, that in such an advanced society we would be facing this problem.”
More people have been falling sick with typhus in Los Angeles County over the last decade, though experts are unsure why. The rise in homelessness is prominent among the theories, which also include warmer temperatures and people spending more time outside.
There were five typhus cases in 2008, compared with 79 cases so far this year, according to the California Department of Public Health.
Typhus spreads when fleas become infected with bacteria known as Rickettsia typhi or Rickettsia felis. The illness reaches humans when fleas bite them or when infected flea feces are rubbed into cuts or scrapes in the skin, according to the U.S. Centers for Disease Control and Prevention.
“It’s very hard to say — these microbes have a mind of their own. They come when they want, and they seem to go when they want,” Spellberg said. “I don’t think anybody really knows.”
Typhus is distinct from typhoid fever, a foodborne illness that is rarely contracted within the United States and can be spread from person to person. Typhus, by contrast, cannot be passed between people.
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