Typhus is caused by 2 types of bacteria: Rickettsia typhi or Rickettsia prowazekii.
Rickettsia typhi causes endemic or murine typhus.
Endemic typhus is uncommon in the United States. It is usually seen in areas where hygiene is poor and the temperature is cold. Endemic typhus is sometimes called "jail fever." The bacteria that causes this type is usually spread from rats to fleas to humans.
Murine typhus occurs in the southern United States, particularly California and Texas. It is often seen during the summer and fall. It is rarely deadly. You are more likely to get this type of typhus if you are around rat feces or fleas, and other animals such as cats, possums, raccoons, and skunks.
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 becomes active again in a person who was previously infected. It is more common in the elderly.
Symptoms of murine or endemic typhus may include:
Dull red rash that begins on the middle of the body and spreads
Fever (can be extremely high 105°F to 106°F, 40.6°C to 41.1°C) that may last up to 2 weeks
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
A complete blood count (CBC) may show a low white blood cell count, anemia, and low platelets. Other blood tests for typhus may show:
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 in up to 60% of patients with epidemic typhus. Those over age 60 have 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.
Jatin M. Vyas, MD, PhD, Associate 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, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.