Typhus used to be a dangerous disease, killing millions of people worldwide. It is a rare condition today and can be treated with antibiotics. However, people who develop typhus still experience many symptoms, which can lead to severe health issues if left untreated.
The most common symptoms of typhus include fever, headaches, nausea, vomiting, and dry cough. At first, it may seem like a typical flu and other airborne diseases.
Types of Typhus
Each type of typhus is transmitted from animals to humans. Even though their symptoms may mimic flu, it does not spread from person to person. Depending on the type of typhus, it can be transmitted by fleas, body lice, chiggers, and ticks.
Advancements in personal hygiene and basic sanitation lowered human exposure to insects, mostly stopping typhus from occurring as a result. However, the infection may still happen, leading to the development of one of the three types of typhus.
Epidemic Typhus
Epidemic typhus (louse-borne typhus, recrudescent, or sporadic typhus) is rare and the most severe form of typhus. It is caused by Rickettsia prowazekii bacteria and usually gets transmitted to humans via lice. The infections mainly occur in overcrowded areas where hygiene and sanitation practices are poor, such as prisons and refugee camps. Animals that carry lice with Rickettsia prowazekii are usually rats, but in very rare instances, the infection may occur due to flying squirrels.
Common symptoms of epidemic typhus include:
- High temperature (fever)
- Chills
- Nausea and vomiting
- Confusion
- Muscle aches
- Headaches
- Red rash that begins on chest, stomach, and back
- Rapid breathing
- Cough
- Sensitivity to light
Rarely, severe forms of epidemic typhus may lead to kidney failure and encephalitis (brain inflammation).
Endemic Typhus
Endemic typhus is also known as murine typhus and jail fever. The infection mainly occurs because of fleas that feed on rodents’ blood (rats, mice, and squirrels) and get infected with the bacteria Rickettsia typhi.
Endemic typhus is similar to epidemic typhus but is less severe. Possible outcomes of the infection include:
- Dry cough
- Diarrhea
- High temperature (fever)
- Headaches
- Fatigue
- Muscle and joint pain
- Red rash that lasts for a short time
- Nausea and vomiting
People who have close contact with rodents are at risk of getting infected with Rickettsia typhi. There is no vaccine to cure or prevent endemic typhus, but it can be prevented by practicing good hygiene, keeping clean living conditions, and reducing exposure to rats.
Scrub Typhus
Scrub typhus is transmitted to humans by chiggers, also known as berry bugs, red bugs, and bush mites. Chiggers are larval mites that live in grass and wooded environments. They may cause scrub typhus if they are infected with Orientia tsutsugamushi bacteria.
Scrub typhus is most often observed in Papua New Guinea, Asia (China, Japan, India), Australia, and the Pacific Islands.
Possible health problems caused by scrub typhus are as follows:
- Swollen lymph nodes
- Rash
- Fatigue
- Dark scab at the site of the bite
- Confusion
- Cough
Severe cases of scrub typhus may also cause organ failure and bleeding. All three types of typhus can be easily and quickly treated with antibiotics. Complications, including injury to kidneys and brain, may occur if treatment is applied late.
How Does Typhus Disease Develop?
The incubation period slightly varies depending on the type of typhus. On average, symptoms appear after 14 days after you get bitten by lice, fleas, mites, or ticks. People who travel to typhus-prone countries, overcrowded areas, or visit risk places such as homeless and refugee camps may not realize they get bitten and infected with one of the typhus types. Many people start noticing symptoms after returning home and wonder why they are sick. If typhus does not cause rash, narrowing down the possible causes may be difficult.
Risk Factors
Several factors increase the risk of getting infected with typhus disease. The most notable ones include the following:
- Visiting typhus-prone areas, including least-developed countries, refugee camps, prisons, port cities, disaster zones, poverty areas, and homeless camps
- Visiting rodent-infested areas
- Close contact with animals, especially rats and wild animals
- Spending time in overcrowded areas that have low hygiene and sanitation standards
Travelers visiting certain developing countries are also at risk of getting infected with typhus. The most typhus-prone countries include African countries, most countries of South Asia and the Middle East, Papua New Guinea, India, Bangladesh, and Pakistan. If you decide to visit one of these regions, follow precautionary tips to reduce the risk of typhus.
Complications
Untreated typhus may lead to the development of severe and even life-threatening health issues. These include:
- Hypovolemia: Hypovolemia occurs when the blood volume circulating in your body is not high enough. The blood volume consists of lymphatic fluid, water, and blood. If your body starts losing these fluids, several symptoms may occur, including fatigue, dizziness, and muscle cramps.
- Septic shock: If your blood pressure drops to a very low level, you may develop a dangerous condition called septic shock. It may occur after a bacterial infection such as typhus and, in rare instances, fungi or viral infection. Septic shock begins with weakness, rapid breathing and heart rate, and chills.
- Pneumonia: Pneumonia is an infection affecting alveoli (lung’s air sacks). Inflamed alveoli may fill up with pus or fluid and cause various health problems. The most common complaints include chills, cough, fever, shallow breathing, and shortness of breath.
- Brain inflammation: Brain inflammation is known as encephalitis. It can develop due to bacterial infection but also autoimmune inflammation, insect bites, and viral infection. Most people who develop this condition experience high body temperature, headaches, weakness, joint and muscle aches, confusion, and muscle weakness.
Other complications that may occur include:
- Low blood pressure
- Internal bleeding
- Enlarged spleen
- Kidney damage
- Liver damage
- Gastrointestinal bleeding
Diagnosis and Tests
Medical professionals diagnose typhus by combining the information they obtain from physical exam, patient’s medical history, visual examination, and tests to determine the presence of typhus bacteria.
Diagnosis of typhus can be challenging, but some information may help a doctor to narrow down the possible causes. For instance, one clue is when flu-like symptoms such as headache, high body temperature, fatigue, and body aches are accompanied by a red rash. However, not everyone notices it, especially in cases of endemic typhus, where the rash lasts for a short time. If a doctor suspects typhus or another rare disease, they will ask if you traveled recently or spent time in crowded areas.
Typhus cannot be diagnosed based only on a physical exam and requires tests to be ruled out or confirmed. These usually include:
- Western blot – This laboratory test is used to determine the presence of a specific protein in tissue or blood samples.
- Skin biopsy – If the red rash is present, a doctor may take a skin sample from the affected area to examine it under a microscope. A variety of skin conditions, cancers, and infections can be diagnosed this way.
- Immunofluorescence test – In this test, fluorescent dyes are used to determine if typhus antigens are present in serum.
Early diagnosis of all three types of typhus is crucial to avoid complications of late typhus. If you have recently been bitten by an insect and experience headaches, rash, fatigue, or body aches, seek medical attention as soon as possible. You will need to undergo antibiotic therapy to get rid of the symptoms.
Health Conditions Similar to Typhus
Symptoms of typhus are similar to other infectious conditions, which makes it a diagnostic challenge. Three diseases may mimic typhus:
- Malaria: Malaria is a mosquito-borne disease. Its common symptoms include chills, high body temperature, fatigue, muscle aches, nausea, and vomiting.
- Brucellosis: Brucellosis is a disease of bacterial origin caused by various bacteria from Brucella species. It mainly infects cattle, sheep, goats, dogs, and swine but can pass to humans if they have close contact with affected animals. Its symptoms share many similarities to typhus and malaria.
- Dengue: Also known as breakbone fever, dengue is a viral infection that spreads to people by mosquito bites. In most cases, dengue doesn’t cause any symptoms. Telling the difference between dengue and previously mentioned diseases is challenging as it also leads to tiredness, muscle aches, fever, rash, and nausea.
Is Typhoid Similar To Typhus?
“Typhoid” and “typhus” may sound similar, but they refer to different health conditions with distinct causes, symptoms, and ways they get transmitted. While both diseases can lead to serious health issues if left untreated, they are caused by different bacteria and passed to humans through other means.
Typhoid fever, caused by the bacterium called Salmonella typhi, is a systemic infection that primarily affects the gastrointestinal system. Unlike typhus, typhoid is not transmitted by insects but through contaminated food and water. It is more commonly associated with regions that have inadequate sanitation and water treatment facilities.
Typhoid fever typically causes symptoms such as high fever, abdominal pain, diarrhea, constipation, headache, and weakness. No characteristic rash is associated with typhoid, which sets it apart from typhus.
Typhoid and typhus share some common symptoms – distinct diseases caused by different pathogens and transmitted through various routes.
Conventional Treatment
All forms of typhus are treated with antibiotics. People who start treatment early usually get rid of symptoms in 7 to 10 days. In some cases, full recovery may take longer. If treatment is delayed, additional health issues may develop, complicating the healing process.
Patients must complete the entire course of antibiotics even if they start feeling better before the medication is finished. This helps ensure complete eradication of the bacteria and reduces the risk of recurrence.
Severe and Untreated Typhus
In very rare scenarios, untreated endemic typhus may lead to life-threatening complications and even death. Its death rate is 2% of untreated cases, which is way less than epidemic typhus (10 to 60% of deaths). Untreated typhus has the highest death rate in people over 60 years old.
Hospitalization may be necessary in cases of severe typhus or complications like pneumonia or encephalitis. Hospital care can provide supportive treatment, such as intravenous fluids and medications, to manage symptoms and prevent complications. Patients with severe typhus may also require close monitoring of vital signs and organ function.
If you suspect you have typhus or have been in an area with a risk of typhus transmission, seek medical attention promptly. Swift diagnosis and treatment significantly increase the chances of a full recovery and minimize the risk of infection complications.
How to Prevent Typhus?
While certain practices may lower the risk of typhus infection, obtaining complete immunity to this disease is not possible. According to the experts, avoiding insects that transmit typhus bacteria (lice, ticks, fleas) is one of the most critical factors in lowering the chance of infection. Typhus bacteria is most likely present in rodent-prone areas, so reducing the population of rats and mice is an effective countermeasure against outbreaks.
However, vectors infected with bacteria may also be found on domestic animals. In this case, treating animals and regularly cleaning their skin can limit human exposure to infected insects.
Many experts believe that an effective way to prevent typhus is to combine several strategies and efforts:
- High-quality sanitation practices
- Fle=control measures
- Observing and controlling the population of rodents, especially in risk areas (ports, refugee and homeless camps)
- Using insecticides and repellents against lice and fleas if they are present in the local environment
- Maintaining good personal hygiene
Key Facts
Typhus is a group of infectious diseases caused by different bacteria and transmitted to humans through insect vectors such as ticks, lice, fleas, and mites. The three main types are epidemic typhus, endemic typhus, and scrub typhus. While typhus is rare today and can be treated with antibiotics, it can lead to severe health issues if left untreated.
Common symptoms include fever, headaches, nausea, vomiting, and a dry cough, often resembling the flu. Epidemic typhus is the most severe form and is transmitted by lice, while endemic typhus is less severe and spread by fleas that feed on rodents. Chiggers usually transmit scrub typhus.
Early diagnosis through tests like Western blot and skin biopsy is crucial for timely antibiotic treatment. If untreated, typhus can lead to complications like hypovolemia, septic shock, pneumonia, and encephalitis. Understanding the differences between typhus and similar diseases like malaria, brucellosis, and dengue is essential for accurate diagnosis.
Treatment involves antibiotics, with quick initiation ensuring a faster recovery and reducing complications. Severe cases may require hospitalization for supportive care.
Prevention involves basic sanitation practices, maintaining good personal hygiene, controlling rodent populations, and using insecticides when necessary.
Sources
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https://www.cdc.gov/typhus/murine/index.html - CDC. (2020). Epidemic Typhus
https://www.cdc.gov/typhus/epidemic/index.html - CDC. (2020).Scrub Typhus
https://www.cdc.gov/typhus/scrub/index.html - MedlinePlus. (2022). Typhus.
https://medlineplus.gov/ency/article/001363.htm - NIH. (2023). Typhus.
https://rarediseases.info.nih.gov/diseases/7833/typhus - O B. Singh; Prasan K. Panda. (2022). Scrub Typhus.
https://www.ncbi.nlm.nih.gov/books/NBK558901/ - Yassina Bechah et al. (2008). Epidemic typhus.
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