Endemic spotted fever

Flea spotted fever, murine spotted fever, rat spotted fever.

Notifiable rickettsial disease, which is similar to epidemic typhus but milder.

• Pathogen: Rickettsia typhi
• Transmission is by the rat flea

• Like epidemic typhus, but much milder
• Unspecific early stage (cephalgia, exhaustion)
• In the course: Fever, somnolence
• 3-6 days after onset of fever Appearance of roseolae with partly punctate haemorrhages on the trunk, which spread centrifugally. Palmoplantar involvement
• Muscle twitching, tenderness of peripheral nerves, motor restlessness
• Hypotonia
• Bronchitis, conjunctivitis, splenomegaly
• Mostly lice can be detected (pediculosis corporis)
• Facies typhosa: Livid-reddish face

• Anamnesis
• Clinic
• Lice infestation
• BB (mild leukocytosis or leukopenia, eosinophilia, thrombocytopenia), liver and kidney values (elevated transaminases in up to 90%), electrolytes (hyponatremia)
• Lumbar puncture in case of suspected meningitis
• From the 2nd week of illness Weil-Felix reaction (agglutination test)
• From the 3rd week of illness, complement fixation reaction
• From the 3rd week of illness indirect immunofluorescence test

• If necessary, intensive medical measures and transfer to the intensive care unit
• Control of vital signs, fluid balance, electrolytes and protein replacement

Topical therapy

• Jacutin® gel (lindane) 0.3%. Use not recommended due to neurotoxicological side effects. Jacuin® is no longer on the market in Switzerland.
• Loxazole Lot. 1% (reapply after 1 and 2 weeks).
• Permethrin 5% in e.g.: Excipial U Lipolotio.
• Prioderm® Shampoo (reapply after 1 and 2 weeks).
• Paranix® Sprax (dimeticone), exposure time: 15 min, repeat after 7 days if necessary
• Lausweg® foam solution, contact time: 15 min. , repeat after 7 and 14 days
• Rausch Laus stop® cream, contact time: 20 min., repeat after 7 and 14 days.

Systemic therapy

• Doxycycline p.o. 100 mg 2x tgl. for 8-10 days
• Alternatively: Ciprofloxacin p.o 500 mg 2x tgl.
• In severe cases, i.v. glucocorticoids 100 mg/d for 2-3 days
if necessary

1. De Sousa, R., et al., Molecular detection of Rickettsia felis, Rickettsia typhi and two genotypes closely related to Bartonella elizabethae. Am J Trop Med Hyg, 2006. 75(4): p. 727-31.
2. McLeod, M.P., et al., Complete genome sequence of Rickettsia typhi and comparison with sequences of other rickettsiae. J Bacteriol, 2004. 186(17): p. 5842-55.
3. Nogueras, M.M., et al., Serological evidence of infection with Rickettsia typhi and Rickettsia felis among the human population of Catalonia, in the northeast of Spain. Am J Trop Med Hyg, 2006. 74(1): p. 123-6.