TYPHUS FEVER

Febrile infection caused by Rickettsia species

Causes

  • Epidemic louse-borne typhus fever: caused by Rickettsia prowazeki; the common type in Uganda, which is transmitted to man (the reservoir) by lice
  • Murine (endemic) typhus fever: caused by Rickettsia typhi (mooseri) and transmitted by rat fleas. Rats and mice are the reservoir
  • Scrub typhus fever (mite-borne typhus): caused by R. tsutsugamushi and transmitted by rodent mites

Clinical features

  • Headaches, fever, chills, severe weakness, muscle pains
  • Macular rash that appears on the 5th day on the rest of the body except the face, palms, and soles
  • Jaundice, confusion, drowsiness
  • Murine typhus has a similar picture but is less severe

Differential diagnosis

  • Any cause of fever such as malaria, HIV, UTI, or typhoid

Investigations

  • Blood: For Weil-Felix reaction

Management

  • Doxycycline 100 mg every 12 hours for 5-7 daysChild > 8 years: 2 mg/kg per dose
  • Or chloramphenicol 500 mg orally or IV every 6 hours for 5 daysChild: 15 mg/kg per dose

Note

  • One single dose of doxycycline 200 mg may cure epidemic typhus but there is risk of relapse

Prevention

  • Personal hygiene
  • Destruction of lice and rodents