Typhus is a bacterial disease spread by lice or fleas.
Murine typhus; Epidemic typhus; Endemic typhus; Brill-Zinsser disease; Jail fever
Typhus is caused by two 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 become active again in a person who was previously infected. It is more common in older adults.
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.
Exams and Tests
Diagnosis is often based on a physical examination and detailed information about the symptoms. You may be asked if you recall being bit by fleas. If the health care provider suspects typhus, you will be started on medicines right away. Blood tests will be ordered to confirm the diagnosis.
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, 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.
Typhus may cause these complications:
When to Contact a Medical Professional
Call your 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:
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, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 192.
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, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 191.
Raoult D. Rickettsial infections. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 327.
Review Date: 12/1/2018
Reviewed 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.
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