Learn About Typhus

What is the definition of Typhus?

Typhus is a bacterial disease spread by lice or fleas.

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What are the alternative names for Typhus?

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

What are the causes of Typhus?

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

Rickettsia typhi causes endemic or murine 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." The bacteria that cause this type of typhus is usually spread from rats to fleas to humans.
  • Murine typhus occurs in the southern United States, particularly California and Texas. It is often seen during the summer and fall. It is rarely deadly. You are more likely to get this type of typhus if you are around rat feces or fleas, and other animals such as cats, possums, raccoons, and skunks.

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 become active again in a person who was previously infected. It is more common in older adults.

What are the symptoms of Typhus?

Symptoms of murine or endemic typhus may include:

  • Abdominal pain
  • Backache
  • Dull red rash that begins on the middle of the body and spreads
  • Fever, can be extremely high, 105°F to 106°F (40.6°C to 41.1°C) and can last up to 2 weeks
  • Hacking, dry cough
  • Headache
  • Joint and muscle pain
  • Nausea and vomiting

Symptoms of epidemic typhus may include:

  • High fever, chills
  • Confusion, decreased alertness, delirium
  • Cough
  • Severe muscle and joint pain
  • Lights that appear very bright; light may hurt the eyes
  • Low blood pressure
  • Rash that begins on the chest and spreads to the rest of the body (except the palms of the hands and soles of the feet)
  • Severe headache

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.

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What are the current treatments for Typhus?

Treatment includes the following antibiotics:

  • Doxycycline
  • Tetracycline
  • Chloramphenicol (less common)

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.

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What is the outlook (prognosis) for Typhus?

People with epidemic typhus who receive treatment quickly should completely recover. Without treatment, death can occur, with those over age 60 having 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.

What are the possible complications of Typhus?

Typhus may cause these complications:

  • Renal insufficiency (kidneys cannot function normally)
  • Pneumonia
  • Central nervous system damage
When should I contact a medical professional for Typhus?

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

How do I prevent Typhus?

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:

  • Bathing
  • Boiling clothes or avoiding infested clothing for at least 5 days (lice will die without feeding on blood)
  • Using insecticides (10% DDT, 1% malathion, or 1% permethrin)
Body louse, female and larvae
Flea
What are the latest Typhus Clinical Trials?
Azithromycin and Cefixime Combination Versus Azithromycin Alone for the Out-patient Treatment of Clinically Suspected or Confirmed Uncomplicated Typhoid Fever in South Asia; a Randomised Controlled Trial
Summary: Typhoid and paratyphoid (enteric) fever affects more than 11 million children and adults globally each year including 7 million in South Asia. Up to 1% of patients who get typhoid may die of the disease and, in those that survive, a prolonged period of ill health and catastrophic financial cost to the family may follow. In the last 20 years, treatment of typhoid fever with a 7-day course of a sing...
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The Scrub Typhus Antibiotic Resistance Trial (START) Comparing Doxycycline and Azithromycin Treatment Modalities in Areas of Reported Antimicrobial Resistance for Scrub Typhus
Summary: Study type: Randomized Control Treatment Trial~Study population: Male and female patients with ≥15 years of age and acute scrub typhus~Duration: 2 years~Study Design: Prospective, open-label, randomized-controlled treatment trial in patients ≥15 years old admitted to hospital with acute scrub typhus. Randomization into 3 oral treatment arms (each n=59 patients, total n=177): i) 7 days of doxycycli...
What are the Latest Advances for Typhus?
The efficacy and tolerability of antibiotics in scrub typhus: an updated network meta-analysis of randomized controlled trials.
Summary: The efficacy and tolerability of antibiotics in scrub typhus: an updated network meta-analysis of randomized controlled trials.
Evaluation of the Therapeutic Effect of Antibiotics on Scrub Typhus: A Systematic Review and Network Meta-Analysis.
Summary: Evaluation of the Therapeutic Effect of Antibiotics on Scrub Typhus: A Systematic Review and Network Meta-Analysis.
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Socio-demographic and Clinico-epidemiological Study of Scrub Typhus in A Tertiary Care Hospital of Mymensingh, Bangladesh.
Summary: Socio-demographic and Clinico-epidemiological Study of Scrub Typhus in A Tertiary Care Hospital of Mymensingh, Bangladesh.
Who are the sources who wrote this article ?

Published Date: December 24, 2020
Published By: 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, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Blanton LS, Dumler JS, Walker DH. Rickettsia typhi (murine typhus). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 190.

Blanton LS, Walker DH. Rickettsia prowazekii (epidemic or louse-borne typhus). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 189.

Fournier PE, Raoult D. Rickettsial infections. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 311.