• Definition
    • Typhus is a bacterial disease spread by lice or fleas.

  • Alternative Names
    • Murine typhus; Epidemic typhus; Endemic typhus; Brill-Zinsser disease; Jail fever

  • Causes
    • Typhus is caused by 2 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 causes this type 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 becomes active again in a person who was previously infected. It is more common in the elderly.

  • Symptoms
    • 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) that may last up to 2 weeks
      • Hacking, dry cough
      • Headache
      • Joint and muscle pain
      • Nausea
      • Vomiting

      Symptoms of epidemic typhus may include:

      • Chills
      • Confusion
      • Cough
      • Delirium
      • High fever
      • 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
      • Severe muscle pain
      • Stupor

      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.

  • Exams and Tests
    • A complete blood count (CBC) may show a low white blood cell count, anemia, and low platelets. Other blood tests for typhus may show:

  • Treatment
    • 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.

  • Outlook (Prognosis)
    • 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.

  • Possible Complications
  • When to Contact a Medical Professional
    • Call your health care provider if you develop symptoms of typhus. This serious disorder can require emergency care.

  • Prevention
    • 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)
  • References
    • 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.