Typhus fever

Several distinct rickettsiae cause the disease known as typhus in humans. The disease is spread by ticks, mites, fleas, or lice, each agent having a distinct epidemiology, but all causing a disease with signs similar to a bad cold with fever lasting form one to several weeks, chills, headache, and muscle pains, as well as a body rash. There is often a large painful sore at the site of the bite and nearby lymph nodes are swollen and painful.

Epidemic typhus (European, Classic, Louse-borne)

Epidemic typhus is prevalent worldwide. It is an acute disease passed from human to human by the body louse. Endemic foci of epidemic typhus exist in highland populations in Africa and South America, but tourists are at minimal risk of acquiring lice and disease.

The disease is characterized by high fever, intractable headache, and rash. Temperature reaches 104° F in several days and remains high. Headache is generalized and intense. On the 4th to 6th day, the rash develops and spreads. Prostration is due to low blood pressure, may be followed by vascular collapse. Fatalities are rare in children; mortality increases with age.

Tick typhus

Tick typhus, actually a form of spotted fever, is not uncommon in travelers who spend time trekking or on safari in Africa or the Indian subcontinent. Trekkers in southern Africa may be at risk from cattle or wild-animal ticks.

Seek local advice on areas where ticks pose a danger and always check your skin carefully for ticks after walking in a danger area such as a tropical forest. A strong insect repellent can help, and serious walkers in tick areas should consider having their boots and trousers impregnated with benzyl benzoate and dibutylphthalate.

Scrub typhus (Mite-borne typhus)

Scrub typhus is spread by mites that feed on infected rodents and exists mainly on Pacific islands and in southeast and east Asia. You should take precautions if walking in rural areas in South-East Asia. Incidence is highest during the spring and summer when the activity of humans brings them in contact with mites seeking animal hosts.

Onset is sudden with fever, chills, headache, and generalized swelling of lymph nodes. At onset of fever, a red lesion develops at the site of the bite. High fever to 104 °F develops during the first week as well as a severe headache. A cough is present during the first week of fever and pneumonia may develop. A rash also develops on the torso often extending to the arms and legs.

Murine typhus (Rat / flea typhus)

Murine typhus is relatively common throughout the world and is transmitted by fleas. It is clinically similar to epidemic typhus, but milder. Highest incidence of cases occurs during the summer months when rats and their fleas are most active and abundant.

Symptoms include chills, headache and fever, lasting about 12 days. Rash and other manifestations are similar to epidemic typhus.

Prevention, vaccination and treatment of typhus

Prompt removal of attached ticks and use of repellents to prevent tick attachment provide the best preventions against tick typhus. Laundering of louse-infested clothing is the most effective means to avoid person-to-person spread of lice and prevent epidemic typhus. Precautions taken when walking in rural areas and the use of insect repellents will help prevent tick and mite-borne typhus.

Vaccination against typhus is not required by any country as a condition for entry. Treatment of all forms of typhus is similar. Chloramphenicol, doxycycline or other forms of tetracycline result in rapid resolution of fever and relapses are infrequent.

Production of typhus vaccine in the United States has been discontinued and there are no plans for commercial production of a new vaccine.

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