Typhus is a bacterial disease spread by lice or fleas.
Typhus is caused by 2 types of bacteria: Rickettsia typhi or Rickettsia prowazekii.
Rickettsia typhi causes endemic or murine 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 becomes active again 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.
Treatment includes the following antibiotics:
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.
People with epidemic typhus may need oxygen and intravenous (IV) fluids.
People with epidemic typhus who receive treatment quickly should completely recover. Without treatment, death can occur in up to 60% of patients with epidemic typhus. Those over age 60 have the highest risk of death.
Only a small number of untreated people with murine typhus may die. Prompt antibiotic treatment will cure nearly all people with murine typhus.
Typhus may cause these complications:
Call your health care provider if you develop symptoms of typhus. This serious disorder can require emergency care.
Avoid being in 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
Blanton LS, Dumler JS, Walker DH. Rickettsia typhi (Murine typhus). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 192.
Blanton LS, Walker DH. Rickettsia prowazeckii (Epidemic or louse-borne typhus). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 191.
Raoult D. Rickettsial infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 335.
Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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