Typhus is a bacterial disease spread by lice or fleas.
Typhus is caused by one of two types of bacteria: Rickettsia typhi or Rickettsia prowazekii.
Rickettsia typhi causes murine or endemic typhus.
Rickettsia prowazekii causes epidemic typhus. It is spread by lice. Brill-Zinsser disease is a mild form of epidemic typhus. It occurs when the bacteria re-activates in a person who was previously infected. It is more common in the elderly.
Symptoms of murine or endemic typhus may include:
Symptoms of epidemic typhus may include:
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 small areas of bleeding into the skin (petechiae).
Treatment includes antibiotics such as:
Tetracycline taken by mouth can permanently stain teeth that are still forming. It is usually not prescribed for children until after all of their permanent teeth have grown in.
Patients with epidemic typhus may need intravenous fluids and oxygen.
Without treatment, death may occur in 10 - 60% of patients with epidemic typhus. Patients over age 60 have the highest risk of death. Patients who receive treatment quickly should completely recover.
Less than 2% of untreated patients with murine typhus may die. Prompt antibiotic treatment will cure nearly all patients.
Call your health care provider if you develop symptoms of typhus. This serious disorder can require emergency care.
Avoid areas where you might encounter rat fleas or lice. Good sanitation and public health measures reduce the rat population.
Measures to get rid of lice when an infection has been found include:
Murine typhus; Epidemic typhus; Endemic typhus; Brill-Zinsser disease; Jail fever
Dumler JS, Walker DH. Rickettsia typhi (Murine typhus). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 191.
Raoult D. Rickettsial infections. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 335.
Walker DH, Raoult D. Rickettsia prowazeckii (Epidemic or louse-borne typhus). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 190.
Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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