Endemic typhus fever
Last Updated: 2019-08-27
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.
- Bronchitis, conjunctivitis, splenomegaly.
- Mostly lice can be detected (Pediculosis corporis)
- Facies typhosa: Livid-red face.
- Medical history.
- 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.
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.
- 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.
- 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.