Endemic typhus fever

Last Updated: 2019-08-27

Author(s): Anzengruber F., Navarini A.

ICD11: -

lea spotted fever, murine spotted fever, rat spotted fever.

Notifiable rickettsiosis, which is similar to epidemic spotted fever but less severe.

  • Causative organism 
    • Rickettsia typhi.
  • Transmission is through the rat flea.

  • Same as epidemic spotted fever, but much milder.
  • Unspecific early stage (cephalgy, fatigue).
  • In history: Fever, somnolence.
  • 3rd - 6th days after onset of fever, occurrence of roseoles with partial punctiform haemorrhages on the trunk, which spread centrifugally. Palmoplantar involvement.
  • Muscle twitching, peripheral nerve tenderness, motor restlessness.
  • Hypotension.
  • Bronchitis, conjunctivitis, splenomegaly.
  • Mostly lice can be detected (Pediculosis corporis)
  • Facies typhosa: Livid-red face.

  • Medical history.
  • Clinic.
  • Lice infestation.
  • Blood count (mild leukocytosis or leukopenia, eosinophilia, thrombocytopenia), liver and kidney values (in up to 90% increased transaminases), electrolytes (hyponatremia)
  • Lumbar puncture for suspected meningitis.
  • From the 2nd week of disease Weil-Felix reaction (agglutination test).
  • Complement fixation reaction from the 3rd week of the disease.
  • Indirect immunofluorescence test after the 3rd week of the disease.

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


Topical Therapy

  • Jacutin® gel (lindane) 0.3%. Application not recommended due to neurotoxicological side effects. Jacuin® is no longer available in Switzerland.

  • Loxazole solder. 1% (reapply after 1 and 2 weeks).

  • Permethrin 5% in e.g.: Excipial U Lipolotio.

  • Prioderm® Shampoo (use again after 1 and 2 weeks).

  • Paranix® Sprax (Dimeticon), application time: 15 min., possibly repeated after 7 days

  • Lausweg® foam solution, reaction time: 15 min. Repeat after 7 and 14 days.

  • Rausch Laus stop® cream, application time: 20 min., repeated after 7 and 14 days.


Systemic Therapy

  • Doxycycline p.o. 100 mg 2x daily for 8-10 days.
  • Alternative: Ciprofloxacin p.o 500 mg 2x daily.
  • In pronounced cases, intravenously glucocorticoids 100 mg/d for 2-3 days.

  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.