Typhus history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Signs and symptoms of typhus fever usually appear abruptly, 8–16 days following exposure to infected lice. Illness can vary from mild to severe, and even life-threatening. Symptoms of acute infection are generally non-specific and include fever and chills, headache, rapid breathing, myalgia, rash, cough, nausea, vomiting and altered mental status.

History

The significant information that needs to focused in the history of the patient includes

• History of travel to endemic areas
• History of tick bite

Symptoms

Type of Typhus fever	Symptoms
Scrub typhus	Fever and chills Headache Myalgia Eschar Altered mental status, ranging from confusion to coma or delirium Lymphadenopathy Rash
Murine typhus	Myalgia Anorexia Nausea Vomiting Abdominal pain Cough Altered mental status
Epidemic typhus	Fever and chills Headache Rapid breathing Myalgia Rash Cough Nausea Vomiting Altered mental status

Rash

Typhus fever	Rash
Scrub typhus	About 25–50% of scrub typhus patients develop a rash. The rash is usually macular or maculopapular. Typically, it will begin on the abdomen of an infected individual and then spread to the extremities. Petechiae are uncommon
Murine Typhus	The rash typically occurs at the end of the first week of the illness and lasts 1–4 days. It generally starts as a maculopapular eruption on the trunk and spreads peripherally, sparing the palms of the hands and soles of the feet. Rash may vary among individuals, or may be absent altogether and should not be relied upon for diagnosis.
Epidemic Typhus	The rash usually begins a couple of days after the onset of symptoms. It typically begins as a maculopapular eruption on the trunk of the body and spreads to the extremities, usually sparing the palms of hands and soles of feet. When the disease is severe, petechiae may develop. The rash may be variable among individuals and stage of infection, or may be absent altogether and should not be relied upon for diagnosis