5-Minute Clinical Consult
Typhus Fevers
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Basics
An infectious disease syndrome caused by several species of Rickettsia resulting in acute, chronic, and recurrent disease
Description
- Acute infection caused by three species of Rickettsia (1)
- Epidemic typhus: human-to-human transmission by body louse; primarily in setting of refugee camps, war, famine, and disaster. Recurrent disease occurs years after initial infection and can be a source of human outbreak. Flying squirrels are a reservoir.
- Endemic (murine) typhus: spread to humans by rat flea bite
- Scrub typhus: infection and infestation of chiggers and of rodents to humans by the Trombiculidae mite “chigger”; primarily in Asia and western Pacific areas
- System(s) affected: endocrine/metabolic; hematologic/lymphatic/immunologic; pulmonary; skin/exocrine
- Synonym(s): louse-borne typhus; Brill-Zinsser disease; murine typhus
Epidemiology
- Epidemic and endemic typhus: rare in the United States (outside of South Texas)
- Scrub typhus: travelers returning from endemic areas
Incidence
Endemic typhus: <100 cases annually, primarily in states around the Gulf of Mexico, especially South Texas; underreporting suspected
Etiology and Pathophysiology
- Epidemic typhus by Rickettsia prowazekii
- Scrub typhus by Rickettsia tsutsugamushi
Risk Factors
- Vector exposure
- Travel to endemic countries
Geriatric Considerations
Elderly may have more severe disease.
General Prevention
Vector control:
- Scrub typhus: protective clothing and insect repellents
- Endemic typhus: ectoparasite and rodent control
- Epidemic typhus: delousing and cleaning of clothing; vaccine for those at high risk of exposure (typhus vaccine production discontinued in the United States)
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Basics
An infectious disease syndrome caused by several species of Rickettsia resulting in acute, chronic, and recurrent disease
Description
- Acute infection caused by three species of Rickettsia (1)
- Epidemic typhus: human-to-human transmission by body louse; primarily in setting of refugee camps, war, famine, and disaster. Recurrent disease occurs years after initial infection and can be a source of human outbreak. Flying squirrels are a reservoir.
- Endemic (murine) typhus: spread to humans by rat flea bite
- Scrub typhus: infection and infestation of chiggers and of rodents to humans by the Trombiculidae mite “chigger”; primarily in Asia and western Pacific areas
- System(s) affected: endocrine/metabolic; hematologic/lymphatic/immunologic; pulmonary; skin/exocrine
- Synonym(s): louse-borne typhus; Brill-Zinsser disease; murine typhus
Epidemiology
- Epidemic and endemic typhus: rare in the United States (outside of South Texas)
- Scrub typhus: travelers returning from endemic areas
Incidence
Endemic typhus: <100 cases annually, primarily in states around the Gulf of Mexico, especially South Texas; underreporting suspected
Etiology and Pathophysiology
- Epidemic typhus by Rickettsia prowazekii
- Scrub typhus by Rickettsia tsutsugamushi
Risk Factors
- Vector exposure
- Travel to endemic countries
Geriatric Considerations
Elderly may have more severe disease.
General Prevention
Vector control:
- Scrub typhus: protective clothing and insect repellents
- Endemic typhus: ectoparasite and rodent control
- Epidemic typhus: delousing and cleaning of clothing; vaccine for those at high risk of exposure (typhus vaccine production discontinued in the United States)
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