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Typhus Fevers

Typhus Fevers is a topic covered in the 5-Minute Clinical Consult.

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Basics

An infectious disease syndrome caused by several rickettsial bacterial organisms resulting in acute, chronic, and recurrent disease (1)[C]

Description

  • Acute infection caused by three species of Rickettsia
    • 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 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 only (rare)

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
  • Endemic typhus by Rickettsia typhi (2)[A]
  • 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: Wear protective clothing and use insect repellents.
  • Endemic typhus: Practice 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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Citation

Stephens, Mark B., et al., editors. "Typhus Fevers." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116628/all/Typhus_Fevers.
Typhus Fevers. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116628/all/Typhus_Fevers. Accessed April 18, 2019.
Typhus Fevers. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116628/all/Typhus_Fevers
Typhus Fevers [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116628/all/Typhus_Fevers.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Typhus Fevers ID - 116628 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116628/all/Typhus_Fevers PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -