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Typhus Fever

Epidemic typhus and trench fever, which are caused by Rickettsia prowazkeii and Bartonella quintanta, respectively, are transmitted from one person to another by the human body louse. Contemporary outbreaks of both diseases are rare in most developed countries and generally occur only in communities and populations in which body louse infestations are frequent, especially during the colder months when louse-infested clothing is not laundered. Foci of trench fever have also been recognized among homeless populations in urban centers of industrialized countries.

Health-care workers who care for these patients may be at risk for acquiring louse-borne illnesses through inhalation or inoculation of infectious louse feces into the skin or conjunctiva. In the eastern United States, campers, inhabitants of wooded areas, and wildlife workers can acquire sylvatic epidemic typhus if they come in close contact with flying squirrels, their ectoparasites, or their nests, which can be made in houses, cabins, and tree-holes.

Symptoms of endemic typhus include severe headache, high fever (104 degrees Fahrenheit), cough, arthralgia, muscle pain (myalgia), chills, low blood pressure, stupor, delirium, extreme sensitivity to light, and a rash that begins on chest and spreads to the rest of the body (except the palms of the hands and soles of the feet). 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 petechiae.

Murine typhus, which is caused by infection with Rickettsia typhi, is transmitted to humans by rat fleas, particularly during exposure in rat-infested buildings (3). Flea-infested rats can be found throughout the year in humid tropical environments, especially in harbor or riverine environments. In temperate regions, they are most common during the warm summer months. Similarly, cat-flea rickettsiosis, which is caused by infection with Rickettsia felis, occurs worldwide from exposure to flea-infested domestic cats and dogs, as well as peridomestic animals, and is responsible for a murine typhus-like febrile disease in humans.

The symptoms of murine typhus include headache, backache, arthralgia, extremely high fever (105 to 106 degrees Fahrenheit), which may last up to 2 weeks, a dull red rash that begins on middle of the body and spreads, nausea, vomiting, hacking, dry cough, and abdominal pains.

The incubation period for typhus fever is roughly 1-2 weeks. Without treatment, death may occur in 10 - 60% of patients with epidemic typhus and in less than 2% of murine typhus. There are no commercially licensed vaccine in the United States.

Treatment includes antibiotics such as tetracycline, doxycycline, or chloramphenicol. Tetracycline taken by mouth can permanently stain teeth that are still forming. It is usually not prescribed for children until after all the permanent teeth have grown in. Intravenous fluids and oxygen may be necessary for patients with epidemic typhus. With treatment, less than 1% of infections are fatal.