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Typhus Fever - Causes, Symptoms and Treatment

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Epidemic typhus, also known as louse-borne typhus, is a rare disease caused by the bacteria Rickettsia prowazekii. Read the following article to know more.

Written by

Dr. Geethika. B

Medically reviewed by

Dr. Kaushal Bhavsar

Published At September 14, 2022
Reviewed AtDecember 1, 2023


People contract epidemic typhus through contact with infected body lice. Though epidemic typhus killed millions in previous centuries, it is now considered a rare disease. Occasionally, cases persist in areas where extreme overcrowding is common, and body lice can spread from person to person. In addition, rare cases of epidemic typhus, known as sylvatic typhus, can occur in the United States. These incidents occur when people come in contact with flying squirrels and their nests.

What is Typhus?

Typhus is a bacterial infection caused by one or more rickettsial bacteria. When fleas, mites (chiggers), lice, or ticks bite, they transmit the infection. Arthropods are invertebrate animals, including fleas, mites, lice, and ticks. When arthropods carrying rickettsial bacteria bite someone, the bacteria that causes typhus is transmitted. Scratching the bite opens the skin, giving the bacteria more access to the bloodstream. As a result, the bacteria reproduce and grow in the bloodstream.

Typhus is classified into three types:

  • Epidemic (louse-borne) typhus.

  • Endemic (murine) typhus.

  • Scrub typhus.

The type of typhus is determined by the source of the infection. Arthropods typically carry a strain of typhus that is unique to their species. Typhus outbreaks are typically limited to developing countries or areas of poverty, with poor sanitation and close human contact. Typhus is not usually a problem in the United States, but it is possible to become infected while traveling abroad.

Typhus, if left untreated, can cause serious complications and even death. Therefore, if someone is suspected of having typhus, they should immediately consult their doctor.

What Are the Symptoms of Typhus?

The most common signs and symptoms are:

  • Breathing quickly.

  • Chills and fever.

  • Aches and pains throughout the body.

  • Headache.

  • Cough.

  • Nausea.

  • Vomiting.

  • Confusion.

  • Rash.

Epidemic typhus symptoms typically appear suddenly and it includes:

  • Excruciating headache.
  • Rash that appears first on the back or chest and then spreads.

  • High fever (temperatures above 102.2°F).

  • Stupor and the appearance of being out of touch with reality.

  • Sensitivity to bright lights in the eyes.

  • Confusion.

  • Severe muscle ache.

  • Blood pressure is too low (hypotension).

Endemic typhus symptoms last 10 days to 12 days and are similar to epidemic typhus symptoms but are usually less severe. They are as follows:

Scrub typhus patients experience the following symptoms:

  • Swelling of lymph nodes.

  • A red lesion or sore on the skin at the bite site.

  • Tiredness.

  • Rash.

  • Cough.

On average, the disease takes five to fourteen days to incubate. This means symptoms may not appear for up to five to fourteen days after being bitten. Travelers who contract typhus while abroad may not experience symptoms until they return home. This is why it is critical to inform the doctor about recent travels.

What Are the Causes of Typhus?

Typhus is not spread from person to person like the common cold or the flu. Typhus is classified into three types, each caused by a different bacterium and transmitted by a different type of arthropod.

  • Typhus of Epidemic or Louse-Borne Origin:

This type is spread by body louse and possibly ticks and is caused by Rickettsia prowazekii. It can be found all over the world, including the United States, but it is most common in areas with a high population and poor sanitation, which promotes lice infestation.

  • Typhus of Endemic Origin:

This type, also known as murine typhus, is caused by Rickettsia typhi and is transmitted by the rat or cat flea. Endemic typhus can be found all over the world. It may be found in people who have had close contact with rats. Although it is not commonly found in the United States, cases have been reported in a few states, primarily Texas and southern California.

  • Typhus of the Scrub Origin:

This type is transmitted by chigger mites in their larval stage and is caused by Orientia tsutsugamushi. This typhus is more common in Asia, including Australia, Papua New Guinea, and the Pacific Islands. Tsutsugamushi disease is another name for it.

When a louse, flea, tick, or mite feeds on the blood of an infected person (epidemic typhus) or an infected rodent, it becomes a carrier of the bacteria (any of the three typhus forms mentioned above). A person can become infected if they come into contact with these bacterium-carrying arthropods (for example, by sleeping on lice-infested bed sheets). In addition to being transmitted through the skin by their bites, the bacteria can also be transmitted through their feces. If the area where lice or mites have been feeding is scratched, it can lead to the entry of bacteria in their feces through the tiny wounds.

What Is the Treatment for Typhus?

The following antibiotics are commonly used to treat typhus:

  • The preferred treatment is Doxycycline.

  • Chloramphenicol is a non-pregnant or breastfeeding woman's option

  • Ciprofloxacin is a medication used to treat adults unable to take Doxycycline.

What Are the Complications of Typhus?

Among the typhus complications are:

  • Hepatitis, or inflammation of the liver.

  • Gastrointestinal hemorrhage or bleeding in the intestines.

  • Hypovolemia, or a decrease in blood fluid volume.

How Can Typhus Be Prevented?

Prevention suggestions include:

  • Maintaining proper personal hygiene (helps guard against lice carrying the disease).

  • Regulating the rodent population (rodents are known to carry arthropods).

  • Avoid travel to areas where typhus has been reported or to countries where there is a high risk due to a lack of sanitation.

  • Doxycycline chemoprophylaxis (used as a preventive only in those at high risk).


Early antibiotic treatment is very effective, and relapses are uncommon if the entire course of antibiotics is taken. Treatment delays and misdiagnosis can result in a more severe case of typhus. Typhus epidemics are more common in poor, unsanitary, and crowded areas. The overall mortality rate for untreated typhus is affected by the type of typhus as well as other factors such as age and overall health. The elderly and those who are malnourished have the highest rates. Typhus is usually curable in children. People who have underlying diseases are also at a higher risk of death. Untreated epidemic typhus can have a mortality rate of 10% to 60%, and untreated scrub typhus can have a mortality rate of up to 30%.

Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)


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