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.

  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.