Typhus

What is typhus?

Typhus (or typhus fever) is the name used for several different types of bacterial infections spread by bug bites that cause similar symptoms, like high fever and rash. These symptoms can be severe and lead to serious complications if left untreated.

Many people think typhus no longer exists, but you can still get it today. Historically, millions of people died from epidemic typhus outbreaks, usually during war, famine or other times of crisis. Today, it’s considered rare. On the other hand, millions of people worldwide still get sick with scrub typhus every year.

What are the types of typhus?

There are three types of illnesses commonly called typhus:

• Murine typhus. Murine (or endemic) typhus exists in many areas of the world, including the U.S. It tends to be milder than epidemic or scrub typhus. Fleas spread murine typhus.
• Epidemic typhus. Epidemic (or sylvatic) typhus is most common in parts of Africa, Central America and South America. Body lice spread epidemic typhus. There are some cases of epidemic typhus in the U.S., usually after exposure to infected flying squirrels.
• Scrub typhus. Scrub typhus exists in rural areas of Southeast and East Asia, the Pacific Islands, Russia and Australia. Chiggers (young mites) spread scrub typhus.

What are the symptoms of typhus?

Symptoms of typhus can include:

• High fever (over 104 degrees Fahrenheit/40 degrees Celsius) that can last several days or weeks.
• Chills.
• Body aches.
• Headache.
• Rash.*
• Cough.
• Nausea or vomiting.
• Stomach pain.
• Swollen lymph nodes.
• Confusion or altered mental state.
• Seizures.
• Coma.
• Eschar — a dark, scab-like area around the chigger bite (in scrub typhus).

*The rash usually appears a few days after other symptoms. It starts on your trunk and spreads to the rest of your body (except the palms of your hands and soles of your feet).

Symptoms are slightly different depending on the type of typhus. Not everyone experiences every symptom.

What causes typhus?

Bacteria cause all three types of typhus:

• Rickettsia typhi causes murine typhus.
• Rickettsia prowazekii causes epidemic typhus.
• Orientia tsutsugamushi causes scrub typhus.

How does typhus spread?

Typhus spreads when a flea, louse (lice) or chigger carrying typhus bacteria bites you and their poop gets into the bite. Different types of bugs spread different types of typhus:

• Cat fleas (Ctenocephalides felis) and rat fleas (Xenopsylla cheopis) spread murine typhus. Despite their names, cats and rats aren’t the only animals that can carry the types of fleas that spread typhus. Dogs, mice, opossums, raccoons, squirrels and other rodents also carry them.
• Body lice spread epidemic typhus. Body lice are most common where a lot of people live in crowded conditions without access to basic hygiene services, like running water, soap and clean clothes. In the U.S., flying squirrels can also carry infected lice.
• Chiggers spread scrub typhus. Chiggers live in areas with lots of grass or brush.

Is typhus contagious?

No, none of the three types of typhus are contagious (spread from person to person). But in crowded living conditions, lice can spread typhus bacteria from one person to another.

What are the risk factors for typhus?

You’re at risk for typhus if you’re around fleas, body lice or chiggers in areas where they carry the bacteria that cause it.

What are the complications of typhus?

Left untreated, typhus can lead to multiple complications, including:

• Blood clots.
• Enlarged spleen (splenomegaly).
• Facial paralysis.
• Gangrene.
• Hearing loss.
• Meningitis.
• Myocarditis.
• Optic neuritis.
• Pleural effusion.
• Pneumonia.
• Respiratory failure.

If you get typhus in the early stages of pregnancy, you have a higher risk of miscarriage, preterm birth and low birth weight.

How is typhus diagnosed?

A provider usually diagnoses typhus based on your symptoms and whether you live in or have traveled to an area where you could’ve been infected. They may also get a blood test or test a sample of the skin around the eschar (biopsy). Make sure to tell your provider if you’ve traveled recently or could’ve been bitten by fleas, lice or chiggers — even if you don’t remember being bitten.

If your provider gets a blood test or biopsy, it can take several weeks to get the results. You may also need to get multiple blood tests over a few weeks. Your provider will need to treat you before they know whether the test is positive.

Is there a cure for typhus?

Yes, antibiotics can cure a typhus infection. Providers usually treat murine, epidemic and scrub typhus with doxycycline. If you’re pregnant or have other health conditions, your provider might prescribe a different antibiotic.

Can you prevent typhus?

The best way to prevent typhus is to avoid flea, lice and chigger bites. Tips for avoiding bites include:

• Wear bug spray approved for repelling fleas and chiggers when outside.
• Cover as much skin as possible when outside, with long pants and socks and a long-sleeved shirt.
• Wear insect-repellent (permethrin-treated) clothing if you’ll be in areas where you’re likely to be around chiggers, fleas and lice. Don’t apply permethrin directly to your skin.
• Talk to your veterinarian about preventing fleas on your pets.
• Keep rodents (like opossums and rats) away from living, work and play areas. Clean up brush piles and keep trash in covered containers. Make sure your home is sealed in places where rodents could get in. Keep food in sealed containers, especially when you’re outside.
• Shower or bathe your whole body with soap and warm water regularly.
• Change and wash your clothing at least once a week.
• Don’t share bedding, clothing, towels or personal items with others.
• If you have lice on your clothing, wash your clothes with hot water and dry on high heat. If you can’t wash clothing in a machine, you can also kill lice by putting clothing in sealed plastic bags for two weeks.

What can I expect if I have typhus?

If you have typhus, expect to take antibiotics for three days to two weeks, depending on the type. If you don’t treat epidemic typhus, your symptoms could go away on their own, only to come back months or years later (Brill-Zinsser disease). Symptoms of Brill-Zinsser disease are usually milder than the initial typhus symptoms. It rarely causes complications. But lice can spread the infection to other people when your symptoms return.

What are the chances of surviving typhus?

When treated early with antibiotics, all types of typhus have a good prognosis (outlook). Murine typhus is rarely fatal. Morality (death) rates for other types of typhus vary. But experts estimate around 10% to 30% of people die of epidemic and scrub typhus if left untreated.

When should I seek care?

See a healthcare provider if you have symptoms of typhus and you could’ve been bitten by fleas, lice or chiggers (even if you don’t remember being bitten). Let your provider know if you’ve traveled recently.

When should I go to the ER?

Call 911 (or your local emergency services number) or go to the emergency room if you experience symptoms of severe illness, including:

• High fever or fever lasting more than a few days.
• Confusion or other mental changes.
• Seizures.
• Difficulty breathing.
• Chest pain.
• Extreme tiredness or weakness. If you can’t wake someone up or if they’re too weak to get up, call 911.

What questions should I ask my doctor?

It might be helpful to ask your provider:

• How do I take this medication?
• How can I protect myself from fleas, chiggers and lice?
• How can I get rid of lice or fleas where I live?

Is there typhus in the U.S.?

Yes, you can get typhus in the U.S. There are a few dozen reported cases each year. It’s most common in California, Texas and Hawaii.

A note from Cleveland Clinic

Most of the time, bugs are simply annoying. But they can also spread diseases that can make you very sick. While typhus might be rare where you live, it’s still important to know the symptoms, how it spreads and where it’s most common. Talk to a healthcare provider if you have concerning symptoms or are wondering how to reduce your risk of flea, louse or chigger bites.