Merck Manual

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Murine (Endemic) Typhus

(Rat-Flea Typhus; Urban Typhus of Malaya)


William A. Petri, Jr

, MD, PhD, University of Virginia School of Medicine

Reviewed/Revised Jan 2024
  • People with murine typhus have shaking chills, a fever, and a headache, followed a few days later by a rash.

  • To diagnose the infection, doctors test a sample of the rash and sometimes do blood tests.

  • Murine typhus is treated with an antibiotic.

Murine typhus occurs throughout the world, although not many people are infected. The infection is transmitted to people by rat, mouse, and cat fleas.

In the United States, most cases of murine typhus occur in suburban areas of Hawaii, Texas, and California. In these states, the rickettsiae often live in opossums and cats.

Symptoms of Murine Typhus

Symptoms of murine typhus begin about 6 to 18 days after bacteria enter the body. People have shaking chills, fever, and a headache. The fever lasts about 12 days. A rash may appear a few days after other the other symptoms. At first, it occurs only in a few places on the torso, then spreads to the limbs.

Murine typhus rarely causes death, but death is more likely in older adults.

Diagnosis of Murine Typhus

  • A doctor's evaluation

  • Biopsy and testing of the rash

  • Blood tests

The diagnosis of murine typhus is suggested by symptoms.

To confirm the diagnosis, doctors may do an immunofluorescence assay, which uses a sample taken from the rash (biopsy). Or they may use the polymerase chain reaction (PCR) technique to enable them to detect the bacteria more rapidly.

Doctors may do blood tests that detect antibodies to the bacteria. However, doing the test only once is not enough. The test must be repeated 1 to 3 weeks later to check for an increase in the antibody level. Thus, antibody tests do not help doctors diagnose the infection immediately after someone becomes ill but can help confirm the diagnosis later.

Treatment of Murine Typhus

  • An antibiotic

Treatment of murine typhus usually consists of doxycycline (a type of antibiotic called a tetracycline), given by mouth. People take the antibiotic until they improve and have had no fever for 48 hours, but they must take it for at least 7 days.

Although some tetracyclines taken for longer than 10 days can cause tooth staining in children younger than 8 years old, a short course (5 to 10 days) of doxycycline in children of all ages is recommended and can be used without causing tooth staining or weakening of tooth enamel (see also Centers for Disease Control and Prevention (CDC): Research on doxycycline and tooth staining).

Prevention of Murine Typhus

There is no vaccine to prevent murine typhus.

Prevention of murine typhus involves measures to reduce contact with infected fleas.

  • Keeping rodents and other animals away from the home, the workplace, and recreational areas—for example, by removing brush, rock piles, junk, piles of firewood, and food supplies (especially pet food)

  • Wearing gloves if handling sick or dead animals

Drugs Mentioned In This Article

Generic Name Select Brand Names
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 2x , Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs
Emtet-500, Panmycin, Sumycin
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