Epidemic spotted fever

Last Updated: 2023-01-10

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

ICD11: 1C30.0

  • Ricketts 1909.
  • Brill 1910.

Spotted typhus, typhus exanthematicus, classical spotted fever, louse spotted fever.

Extremely rare, notifiable disease caused by Rickettsia prowazekii with high lethality.

  • Pathogen: Rickettsia prowazekii.
  • Incubation period: 7-14 days.
  • Rickettsia prowazekii is transmitted by clothes lice or their faeces. The pathogens enter the body through skin lesions as part of the sucking act.

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

  • History.
  • Clinical.
  • Lice infestation.
  • BB (leucopenia, eosinophilia), liver and kidney values, electrolytes.
  • From the 2nd week of illness. Week of illness Weil-Felix reaction (agglutination test).
  • From the 3rd week of illness complement fixation reaction and indirect immunofluorescence test.

  • Vaccination available.

  • If no early therapy is given, a high lethality is to be expected.
  • In cases where antibiotic therapy is discontinued early, late relapses may occur (Brill-Zinsser disease).
  • After the disease is completely overcome, there is lifelong immunity.

  • 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. In Switzerland, Jacuin® is no longer on the market.
  • 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, exposure time: 15 min. , repeat after 7 and 14 days.
  • Rausch Laus stop® cream, exposure 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, if necessary, i.v. glucocorticoids 100 mg/d for 2-3 days.


  • Dresses and bed linen should be washed at a minimum of 60°C as part of the rehabilitation. Alternatively, these can be placed in airtight plastic bags for 3 days.


  • 2 times a week, all family members should be checked with the lice comb.


  • Cutting the hair is not effective, as even 5 mm long hairs are sufficient to hold nits.


  1. Botelho-Nevers, E., et al., Treatment of Rickettsia spp. infections: a review. Expert Rev Anti Infect Ther, 2012. 10(12): p. 1425-37.
  2. Chapman, A.S., et al., Cluster of Sylvatic Epidemic Typhus Cases Associated with Flying Squirrels, 2004–2006. Emerg. Infect. Dis., 2009. 15(7): p. 1005-1011.
  3. Raoult, D., et al., Outbreak of epidemic typhus associated with trench fever in Burundi. The Lancet, 1998. 352(9125): p. 353-358.
  4. Beutler, M. (2007). Keine Panik bei Läusen!. Pharmajournal, (18), 4-8. Retrieved from http://www.pharmasuisse.org/data/Oeffentlich/de/Publikationen/AKA-Publikationen/07_18_Laeuse_2_d.pdf