EPIDEMIOLOGY

RESERVOIR

MODE OF
TRANSMISSION

INCUBATION PERIOD
PERIOD OF INFECTIVITY
CLINICAL FEATURES
In severe cases of typhus,
mental confusion and
coma may occur.

EPIDEMIC TYPHYS
Occurs in cold regions where
people live in crowded and
unhygienic conditions and are
louse-infected
Mainly in Andes, East and Central
Africa
Associated with war, famine and
refugee camps
Humans mainly
Flying squirrels in US
No transovarian transmission

MURINE TYPHUS
Worldwide
Mainly in areas where there
are large numbers of rats in
residential areas

SCRUB TYPHUS
Rural central, east and south East Asia,
North Australia, Pacific islands
(tsutsugamushi triangle)
Mainly an occupational disease of people
exposed to infested vegetations
Seasonal in temperate climates

Infected larval stages of mites (transovarian

transmission in mites)

Rats and mice (rat-flea-ratcycle)

Fleas (some transovarian
transmission in fleas)
Infected rat flea defecates while
sucking blood of a person and
infection occurs by rubbing of
faeces in bite.

Body louse is infected by feeding

on blood of patients with acute or
recrudescent typhus
Infected lice excrete rickettsia in
their faeces when feeding on other
persons
Infection occurs by rubbing louse
faecal matter or crushed lice into
the bite wound or through
scratching.
1-2 weeks
1-2 weeks
No direct person to person transmission
Humans are infective for lice as long as they have fever
Sudden onset of severe headache,
Similar to epidemic but less
shivers, fever, apathy and tiredness
severe
Macular rash appear after a week
(not in mild infection)

Bites of infected larval mites (directly)

1-3 weeks

At site of painless bite, a flat black scab is

formed (eschar) and is followed by fever,
headache, sweating and lymphadenopathy
Maculopapular rash mainly on trunk and
last a few days
Pnemonitis
Meningoencephalitis, myocarditis,
jaundice, renal failure

DIAGNOSIS

TREATMENT

OUTCOME

PREVENTION

Blood IgM antibodies by immunofluorescence or EIA, LA or CFT

o Positive in 2nd week
o Does not distinguish between the different typhus group Rickettsial infection
PCR on blood useful for early diagnosis but not widely available
Isolation of the organism possible in tissue culture but performed in specialised labs.
Weil- Felix test positive in half cases with Proteus OX-K strain in scrub typhys but cross- reactions with leptospirosis
may occur.
Tetracycline or chloramphenicol for 3-7days as single dose (often effective)
Relapses usually respond to a second course of antibiotics
Clothing and bed linen of patients and contacts should be changed and either washed in hot water or treated with
insecticide.
Rapid defervescence occurs in second week and illness lasts about 2 weeks
Mortality higher in older persons
An attack of scrub typhus confers prolonged immunity against homologous strain only.
o Immunity against heterologous strains is short-term and further attacks with typical illness possible.
Apply an effective insecticide to
Apply insecticide with
Impregnate clothes with miticidal
clothes and people living under
residual action to areas
chemicals (permethrin)
conditions favouring louse
infested with rats
Apply mite repellents to exposed skin in
infestation
areas where scrub typhus occur
Rodent control measures after
o lindane, permethrin, carbaryl
reducing flea population
Eliminate mites from specific sites by
o Beware resistance of lice to
application of insecticide to ground and
certain insecticides
vegetation in camps surroundings
Improve living conditions(bathing
In high-risk areas, prophylactic weekly
and washing clothes)
doxycycline may be used.
Delousing of clothing and living
quarters of household contacts with
insecticides
EPIDEMIC MEASURES
o Systematic application of
insecticide with residual effect
to everyone in affected area
o All immediate contacts should
be quarantined or kept under
surveillance for 2 weeks.