Endemic typhus fever

Last Updated: 2019-08-27

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

ICD11: -

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

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.
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.
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.

Synonym (s)