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Murine (Endemic) Typhus

(Rat-Flea Typhus; Urban Typhus of Malaya)

By William A. Petri, Jr, MD, PhD, Wade Hampton Frost Professor of Medicine and Chief, Division of Infectious Diseases and International Health, University of Virginia School of Medicine

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Murine typhus is caused by Rickettsia typhi and R. felis, which are transmitted to humans by fleas; it is clinically similar to but milder than epidemic typhus, causing chills, headache, fever, and rash.

Murine typhus is a rickettsial disease.

Animal reservoirs include wild rats, mice, and other rodents. Rat fleas and probably cat fleas transmit organisms to humans through bites. Fleas are also natural reservoirs for R. typhi; infected female fleas can transmit organisms to their progeny. Distribution is sporadic but worldwide; the incidence is low but higher in rat-infested areas.

Symptoms and Signs

After an incubation of 6 to 18 days (mean 10 days), a shaking chill accompanies headache and fever. The fever lasts about 12 days; then temperature gradually returns to normal.

The rash and other manifestations are similar to those of epidemic typhus but are much less severe. The early rash is sparse and discrete.

Mortality is low but is higher in elderly patients.


  • Clinical features

  • Biopsy of rash with fluorescent antibody staining to detect organisms

  • Acute and convalescent serologic testing (serologic testing not useful acutely)

  • PCR

For details of diagnosis, see Epidemic Typhus : Diagnosis.


  • Doxycycline

Primary treatment is doxycycline 200 mg po once followed by 100 mg bid until the patient improves, has been afebrile for 48 h, and has received treatment for at least 7 days. Chloramphenicol 500 mg po or IV qid for 7 days is 2nd-line treatment.

Incidence has been decreased by reducing rat and rat flea populations. No effective vaccine exists.

Key Points

  • Murine typhus is transmitted to humans by fleas.

  • Symptoms begin with a shaking chill, headache, and fever; the rash and other manifestations are similar to those of epidemic typhus but are much less severe.

  • Treat with doxycycline or chloramphenicol.