Typhus is caused by one of two types of bacteria: Rickettsia typhi or Rickettsia prowazekii.
Rickettsia typhi causes murine or endemic 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 by 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 rats feces or fleas, and other animals such as cats, opossums, 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 re-activates 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
Extremely high fever (105 - 106 degrees Fahrenheit), which 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 (petechiae).
Signs 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:
Walker DH, Raoult D. Rickettsia prowazeckii (Epidemic or louse-borne typhus). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 190.
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.