Typhus, Endemic (Murine Typhus)

Key Features

• Residing in endemic area

• Fever for 10–14 days

• Headache, chills, myalgia

• Maculopapular rash spreading from trunk to extremities (not on palms and soles) 3–7 days after fever onset

• Definitive diagnosis by serology

Clinical Findings

• No eschar appears at the inoculation site

• Incubation period is 6–14 days

• Headache, myalgia and arthralgia, and chills slowly worsen

• Fever may last 10–14 days

• After 3–7 days, a rash appears

  • Truncal macules and papules spread to the extremities; the rash is rarely petechial and resolves in < 5 days

  • May be absent in 20–40% of patients

• Intestinal and respiratory symptoms may occur

• Prolonged neurologic symptoms can occur

Diagnosis

• Hepatomegaly may be present

• Mild thrombocytopenia and elevated liver enzymes may be present

Treatment

• Doxycycline

  • Drug of choice

  • Should be continued for 3 days after evidence of clinical improvement