Author: Catriona Wootton, Dermatologist, UK, 2017. DermNet NZ Editor in Chief: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. December 2017.
Rickettsiae are small, obligate intracellular, Gram negative bacteria that spend part of their life cycle in an arthropod host (tick, flea, body louse or mite). Humans are infected with the rickettsial organism either via a bite or contact with faeces from an infected arthropod. The disease that develops depends upon the specific bacterium transmitted. Many different bacterial species are classified within the rickettsial group and a variety of different clinical manifestations are seen which vary greatly in terms of severity. The majority of rickettsial diseases result in a rash and some will also result in a cutaneous eschar, aiding diagnosis.
Rickettsial typhi refers to a group of 3 arthropod-borne rickettsial infections that cause typhus fever. They are also called typhus group rickettsial disease.
As the rickettsial diseases are transmitted via arthropods, humans at risk of infection are those who come into contact with the specific arthropod vectors. In the case of rickettsial typhi, the vectors are lice and fleas. The bacteria are transmitted via infected faeces that are either inhaled or rubbed into the skin/mucous membranes.
Louse-borne epidemic typhus is seen in emergency situations where there is overcrowding and washing facilities are limited, for example in refugee camps.
Symptoms develop 7–14 days after inoculation.
The classical triad of symptoms in all rickettsial diseases is:
Rash develops around 3–6 days after the onset of disease.
Complications of typhus include:
In epidemic louse-borne typhus there is a risk of Brill-Zinsser disease – recrudescence months to years later.
Diagnosis of a rickettsial typhus infection is based on the clinical presentation and risk factors for exposure to body lice or fleas. Laboratory confirmation can be difficult and includes:
The differential diagnosis for rickettsia typhi includes any disease causing rash, fever and headache.
Rickettsial infections can be treated successfully with tetracycline antibiotics, especially doxycycline. Chloramphenicol is the second-line treatment option.
No vaccines exist for rickettsial infections.
Rickettsial infections can be prevented by taking measures to reduce exposure to lice and fleas.
All forms of rickettsial typhus infection can be life-threatening. Murine and sylvatic typhus tend to be much less severe than epidemic typhus.
Brill-Zinsser disease is a potential complication of epidemic typhus, where there is a recrudescence of the disease months to years later; this is typically milder than the original disease.
See the DermNet NZ bookstore.
© 2018 DermNet New Zealand Trust.
DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice.