What Is Typhus?
Typhus is a group of infections caused by rickettsiae, a group of unusual bacteria. Rickettsiae are like other bacteria in that they can be killed by antibiotics. They are also like viruses, however, in that they must invade living cells in order to grow. There are three main types of typhus: epidemic, murine, and scrub.

Epidemic typhus, caused by Rickettsia prowazekii, is a severe form of the disease spread by human body lice. In the United States, this type of typhus also occasionally is spread by lice and fleas on flying squirrels. Sometimes the symptoms of people with typhus become active again years after the original attack; this is called Brill-Zinsser disease. Brill-Zinsser disease is milder than epidemic typhus.

Murine typhus, caused by Rickettsia typhi, is a milder form of the disease and is spread by fleas on rats, mice, and other rodents.

Scrub typhus, caused by Rickettsia tsutsugamushi, is a form of the disease found in the Asian-Pacific area bounded by Japan, Australia, and the Indian subcontinent. It is spread by mites on rats, field mice, and other rodents.

Who Gets Typhus?
Both epidemic and murine typhus are found around the world. However, epidemic typhus is most common in situations where poor hygiene and crowded living conditions exist. Epidemic typhus is rare in the United States. Murine typhus is most common in rat-infested areas. It is the only type of typhus that occurs regularly in the United States, but fewer than 100 cases a year are reported, mainly in Texas and California.

What Happens When People Have Typhus?
Symptoms
The symptoms of typhus include fever, headache, chills, and general aches that are followed by a rash. The rash spreads to most of the body but usually does not affect the face, palms of the hands, or soles of the feet. In murine typhus, the symptoms are similar but milder. In epidemic and scrub typhus, the fever may rise as high as 104 to 105 degrees Fahrenheit and stay high for about two weeks. The headache is intense.

In severe cases of typhus, blood pressure may drop dangerously. Severe illness also may lead to confusion, seizures, coma, or even death. This accounts for the disease's name, which comes from the Greek word "typhos," meaning smoke, a cloud, or a stupor arising from a fever.

Diagnosis and Treatment
Blood tests are used to show if people are infected with typhus rickettsiae. People with typhus who are treated with antibiotics generally recover. If treatment is begun early, they usually get better quickly. If treatment is delayed, however, the improvement usually is slower, and the fever lasts longer. If left untreated, typhus can damage organs, lead to coma, and even to death.

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