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Murine (Endemic) Typhus

(Rat-Flea Typhus; Urban Typhus of Malaya)

By

William A. Petri, Jr

, MD, PhD, University of Virginia School of Medicine

Last full review/revision Jul 2020| Content last modified Jul 2020
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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 cats, wild opossums, rats, mice, and other rodents. Rat fleas and probably cat fleas and opossum 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 of Murine Typhus

After an incubation of 6 to 18 days (mean 10 days), a shaking chill accompanies headache and fever in patients with murine typhus. 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 older patients.

Diagnosis of Murine Typhus

  • Clinical features

  • Biopsy of rash with fluorescent antibody staining to detect organisms

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

  • Polymerase chain reaction (PCR)

Treatment of Murine Typhus

  • Doxycycline

Primary treatment is doxycycline 200 mg orally once followed by 100 mg twice a day in adults until the patient improves, has been afebrile for 48 hours, and has received treatment for at least 7 days. Chloramphenicol 500 mg orally or IV 4 times a day for 7 days is 2nd-line treatment. Oral chloramphenicol is not available in the US, and its use is associated with adverse hematologic effects, which requires monitoring of blood indices.

Prevention of Murine Typhus

Incidence of murine typhus 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.

Drugs Mentioned In This Article

Drug Name Select Trade
No US brand name
PERIOSTAT, VIBRAMYCIN
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