Snapshot A marine deployed at Mt. Fuji presents to the emergency clinic with "the worst headache of his life," accompanied by fevers, chills, malaise, photophobia, and a macular/papular rash spread across his trunk, face, and upper extremities. Introduction Typhus is a bacterial disease that is caused by Rickettsia prowazekii and Rickettsia typhi Spread via human lice and flea vectors from person-to-person Form of typhus depends on which bacteria caused the infection Rickettsia typhi causes murine or endemic typhus endemic typhus uncommon in the United States occurs in regions with poor hygeine and cold temperatures known as "jail fever" murine typhus occurs in the southeastern and southern United States associated with exposure to rat fleas or feces and other wild animals often spread during the summer or fall seasons rarely fatal Rickettsia prowazekii causes epidemic typhus and Brill-Zinsser disease Brill-Zinsser disease milder form of endemic typhus spread by lice and fleas on flying squirrels caused by reactivation of previous infection more common in the elderly Presentation Symptoms epidemic typhus patients present 1-3 weeks after the bite with symptoms including sudden-onset fever (104 F) chills severe headache maculopapular rash appears 5-9 days after onset of symptoms spreads peripherally from trunk to extremities cough arthalgia myalgia photophobia delirium murine or endemic typhus abdominal pain diarrhea backache headache extremely high fever (105-106 F) may last for up to two weeks dull, red rash begins on the trunk and spreads peripherally hacking, dry cough arthralgia myalgia nausea vomiting Physical exam hypotension fever photophobia early rash light rose color and blanches under pressure late rash dull red that does not fade scattered petechiae may be observed in patients with severe disease Evaluation Labs CBC may show anemia and thrombocytopenia typhus antibody present in individuals with active or previous infection hypoalbuminemia hyponatremia elevated liver enzymes may demonstrate mild kidney failure Differential Rocky mountain spotted fever, Lyme disease Treatment Medical management antibiotic therapy indicated in all types of typhus disease doxycycline tetracycline may permanently stain developing teeth usually not prescribed in children chloramphenicol (less common) intravenous fluids and supplemental oxygen may be indicated in patients with epidemic typhus Complications Renal insufficiency, pneumonia, and central nervous system damage Prevention Avoid fleas and lice Quarantine patients who might have lice/fleas and can spread infection Prognosis Epidemic typhus can be fatal is left untreated in 10-60% of patients caused by peripheral vascular collapse elderly patients are at greater risk Murine typhus is fatal in less than 2% of patients if left untreated If diagnosed and treated early, vast majority of all cases fully recover