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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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  • 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.

Rickettsiae Overview of Rickettsial Infections Rickettsial infections and related infections (such as anaplasmosis, ehrlichiosis, and Q fever) are caused by an unusual type of bacteria that can live only inside the cells of another organism... read more Overview of Rickettsial Infections are a type of bacteria that can live only inside the cells of other organisms. Murine means related to rats and mice. Thus, the rickettsiae that cause murine typhus live mainly in rats and mice (the hosts).

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 people.

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.

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

Treatment of Murine Typhus

  • An antibiotic

Treatment of murine typhus usually consists of the antibiotic doxycycline, 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.

Chloramphenicol is also effective but can have serious side effects and is not available in the United States.

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Chickenpox is a highly contagious viral infection that tends to be fairly mild in most cases. Which of the following groups has the lowest risk of complications from chickenpox?
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