What Is Typhus?
Typhus is a disease caused
by an infection with the Rickettsia bacteria.
Fleas, mites (chiggers), lice, or ticks transmit it when they bite you. Fleas,
mites, lice, and ticks are types of invertebrate animals known as arthropods.
When infected arthropods bite someone, they may leave the bacteria that
cause typhus behind. Scratching the bite opens the skin and allows the bacteria
to enter the bloodstream. Once in the bloodstream, the bacteria reproduce and
There are three different
types of typhus:
- epidemic (or
- endemic typhus
- scrub typhus
The type of typhus you are
infected with depends on what bit you. Arthropods are typically carriers of one
typhus strain unique to their species.
Typhus outbreaks usually
only occur in developing countries or in regions of poverty, poor sanitation,
and close human contact. Typhus is generally not a problem in the United
States, but you may become infected while traveling abroad.
Untreated typhus can lead
to serious complications and it’s potentially fatal. It’s important to see your
doctor if you suspect that you may have typhus.
Cause of Typhus
Typhus is not transmitted
from person to person like a cold or the flu. There are three different types
of typhus and each type is caused by a different type of bacterium and
transmitted by a different type of arthropod.
This type is caused
by Rickettsia prowazekii
and carried by the body louse. It can be found around the world, including in the
United States, but is typically found in areas of high population and poor
sanitation, where conditions promote lice infestation.
Formerly known as murine
typhus, this type is caused by Rickettsia
typhi and is carried by the rat or cat flea. Endemic typhus can be found
worldwide. It may be found among people in close contact with rats or areas
where rats live. It isn’t commonly found in the United States, but cases
have been reported in some areas, primarily Texas and southern California.
This type is caused
by Orientia tsutsugamushi
and carried by mites. This type of typhus is more commonly found in Asia,
Australia, Papua New Guinea, and the Pacific Islands. It is also called
The louse, flea, tick, or
mite becomes infected with the bacteria when they feed on the blood of an
infected person or an infected rodent (in the case of endemic typhus). If you
come in contact with these infected arthropods (for example, by sleeping on bed
sheets infested with lice), their feces may be deposited on your skin when the louse,
flea, tick, or mite feeds on your blood. If you scratch the bite, the bacteria
can enter your bloodstream through the tiny wound on your skin.
Symptoms of Typhus
Symptoms vary slightly by
the type of typhus, but there are symptoms that are associated with all three
types of typhus, such as:
Symptoms of epidemic
typhus usually appear suddenly and
- severe headache
- high fever
(above 104 degrees Fahrenheit)
- rash that
begins on the back or chest and spreads
- stupor and
seeming out of touch with reality
- low blood
sensitivity to bright lights
- severe muscle
The symptoms of endemic typhus last for 10 to 12 days and are very
similar to the symptoms of epidemic typhus but are usually less severe. They
- dry cough
- nausea and
Symptoms seen in people
with scrub typhus include:
- swollen lymph
- red lesion or
sore on the skin at the site of the bite
The incubation period for
the disease is 10 to 14 days, on average. This means that symptoms won’t
usually appear for 10 to 14 days after you are bitten. Travelers who get typhus
while traveling abroad may not experience symptoms until they are back home.
This is why it is important to tell your doctor about any recent trips if you
have any of the above symptoms.
If you suspect that you
have typhus, your doctor will ask about your symptoms and your medical history.
To help with the diagnosis, tell your doctor if you:
- are living in
a crowded environment
- know of a
typhus outbreak in your community
- have traveled abroad
Diagnosis is difficult
because symptoms are common to other diseases, including:
(infectious disease spread by mosquitos)
(infectious disease caused by the brucella bacteria)
Diagnostic tests for the
presence of typhus include:
- skin biopsy
(sample of the skin from your rash will be tested in a lab)
- Western blot
(test to identify presence of typhus bacteria)
test (using fluorescent dyes to detect typhus in samples of sputum, which is the
thick fluid or mucus found in the lungs and the breathing passages)
- blood test
(results can indicate the presence of infection)
Antibiotics most commonly
used to treat typhus include:
(option for those not pregnant or breast-feeding)
(used for those who are unable to take doxycycline)
Some complications of
(infection of the liver)
hemorrhage (bleeding inside the intestines)
(decrease in blood volume)
Outlook for Typhus
Early treatment with
antibiotics is very effective and relapses aren’t common if you take the full
course of antibiotics. Delayed treatment and misdiagnosis can lead to a more
severe case of typhus.
Epidemics of typhus are
more common in poor, unsanitary, and crowded areas. People who are most at risk
of dying are generally those who are unable to afford quick treatments. The
overall mortality rate for untreated typhus ranges from 10 to 40 percent,
according to the Ohio Department of Health. The highest rates are seen in the older adults and
those who are malnourished. Children usually recover from typhus. People with
underlying diseases (such as diabetes mellitus, alcoholism, or chronic renal
disorders) also have a higher risk of mortality.
Endemic typhus is rarely
deadly, even without treatment (less than 4 percent of cases), according to an
article in Clinical Infectious Diseases.
During World War II, a
vaccine was created to prevent epidemic typhus. However, the shrinking number
of cases has stopped the manufacture of the vaccine. The easiest way to prevent
typhus is by avoiding the insects that spread it.
Suggestions for prevention
personal hygiene (helps guard against lice carrying the disease)
the rodent population (rodents are known to carry arthropods)
- avoiding travel
to regions where typhus exposure has occurred, or to countries that are high risk
due to lack of sanitation
with doxycycline (used as a preventive only in those at high risk, such as
those on humanitarian campaigns in areas with extreme poverty and little or no
Use tick and insect
repellant. Perform routine examinations for ticks, and wear protective clothing
if you’re traveling near an area where there have been typhus outbreaks.