What's in this article?
Typhus is a sudden severe illness caused by infection with Rickettsia bacteria.
Outbreaks of typhus tend to occur in developing countries and areas where there is poverty, homelessness, close human contact and poor sanitation.
The Rickettsia bacteria that cause typhus are carried by body lice, ticks, mites and fleas.
This page covers the main types:
- epidemic typhus (the most serious form) – this type occurs in Africa, South America and Asia, and is transmitted by body lice
- endemic typhus (the milder form of the disease) – it occurs throughout the world and is transmitted by ticks, mites and fleas
- scrub typhus (also called Tsutsugamushi fever) – this type is caught from mites infected with Orientia tsutsugamushi bacteria, which live in heavy scrub vegetation in parts of rural southeast Asia, Oceania and northern Australia
Typhus is generally not a problem in the UK. But you may become infected abroad if you catch Rickettsia-infected lice from infested people or bedding (in budget accommodation or on a sleeper train, for example), or if you are bitten by a Rickettsia-infected tick, mite or flea.
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 grow.
There are three different types of typhus:
- epidemic (or louse-borne) typhus
- 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.
Symptoms of murine or endemic typhus may include:
- Abdominal pain
- Dull red rash that begins on the middle of the body and spreads
- Extremely high fever (105 – 106 degrees Fahrenheit), which may last up to 2 weeks
- Hacking, dry cough
- Joint and muscle pain
Symptoms of epidemic typhus may include:
- High fever (104 degrees Fahrenheit)
- Joint pain (arthralgia)
- 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 (myalgia)
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 (petechiae).
Treatment for Typhus
Antibiotics most commonly used to treat typhus include:
- doxycycline (preferred treatment)
- cholramphenicol (option for those not pregnant or breast-feeding)
- ciprofloxacin (used for those who are unable to take doxycycline)
What are the possible complications?
If typhus is not diagnosed and treated promptly, there is a risk of developing complications, including:
- long-term hearing loss or tinnitus
- low blood pressure
- organ damage and kidney failure
- secondary bacterial infection, such as pneumonia
The patient may need to have hospital follow-up for some months after recovering from an attack of typhus to receive treatment for these long-term problems.