Health Encyclopedia

Typhus

Definition

Typhus is an infectious disease that is spread by lice or fleas.

Alternative Names

Murine typhus; Epidemic typhus; Endemic typhus; Brill-Zinsser disease; Jail fever

Causes, incidence, and risk factors

Typhus is caused by one of two types of bacteria: Rickettsia typhi and Rickettsia prowazekii.

The type of typus depends on which bacteria causes the infection.

Rickettsia typhi causes murine or endemic typhus. Endemic typhus is uncommon in the United States. It is usually seen in areas where hygiene is poor and the temperature is cold. Endemic typhus is sometimes called "jail fever." Lice and fleas of flying squirrels spread the bacteria.

Murine typhus occurs in the southeastern and southern United States. Murine typhus is rarely deadly. It is often seen in the summer and fall. Symptoms usually last 2 - 3 weeks. Risk factors for murine typhus include exposure to rat fleas or rat feces, or exposure to other animals (such as cats, opossums, raccoons, skunks, and rats).

Rickettsia prowazekii causes epidemic typhus and Brill-Zinsser disease. Brill-Zinsser disease is a mild form of epidemic typhus. It occurs when the disease re-activates in a person who was previously infected. It is more common in the elderly.

Symptoms

Symptoms of murine typhus may include:

Headache
Backache
Arthralgia
Extremely high fever (105 to 106 degrees Fahrenheit), which may last up to 2 weeks
Dull red rash that begins on middle of the body and spreads
Nausea
Vomiting
Hacking, dry cough
Abdominal pain

Symptoms of endemic typhus may include:

Severe headache
High fever (104 degrees Fahrenheit)
Cough
Arthralgia
Severe muscle pain ( myalgia)
Chills
Low blood pressure
Stupor
Delirium
Lights appear very bright; light may hurt the eyes
Rash that begins on chest and spreads to the rest of the body (except the palms of the hands and soles of the feet)

The early rash is a light rose color and fades when you press on it. Later, the rash becomes dull and red and does not fade. People with severe typhus may also develop petechiae.

Signs and tests

A CBC may show anemia and low platelets. Other blood tests for typhus may show:

Low sodium level
Low level of albumin
Mildly high liver enzymes
Mild kidney failure
High level of typhus antibodies

Treatment

Treatment includes antibiotics such as tetracycline, doxycycline, or chloramphenicol. Tetracycline taken by mouth can permanently stain teeth that are still forming. It is usually not prescribed for children until after all the permanent teeth have grown in.

Intravenous fluids and oxygen may be necessary for patients with epidemic typhus.

Expectations (prognosis)

Without treatment, death may occur in 10 - 60% of patients with epidemic typhus. Patients over the age of 60 have the highest risk of death. When treatment is promptly received, the patient is expected to completely recover.

Less than 2% of untreated patients with murine typhus may die. Prompt antibiotic treatment will cure nearly all patients.

Complications

Calling your health care provider

Call your health care provider if symptoms of any type of typhus develop. This serious disorder can require emergency care.

Prevention

Avoid areas where rat fleas or lice might be encountered. Good sanitation and public health measures reduce the rat population.

Review Date:9/25/2006
Reviewed By:Charlotte Grayson, MD, Private Practice specializing in Internal Medicine and Infectious Disease, Smyrna, GA. Review provided by VeriMed Healthcare Network.

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