Typhus is a disease caused by the bacteria Rickettsia typhi or Rickettsia prowazekii that is spread by lice and fleas. Rickettsia prowazekii causes epidemic typhus and a mild form of typhus known as Brill-Zinsser disease, while Rickettsia typhi causes murine (endemic) typhus--a similar but milder form of epidemic typhus. Symptoms can become life-threatening without treatment, so seek prompt medical care if any symptoms.
Cardinal Symptoms
Both epidemic typhus and murine (endemic) typhus are characterized by cardinal symptoms of headache, fever and rash. According to the Merck Manuals Online Medical Library, individuals with murine typhus generally develop a headache and fever between 6 to 18 days after infection. The fever may reach 104 to 106 degrees Fahrenheit, according to the National Institutes of Health, and typically lasts for about 12 days before slowly return to normal.
Individuals with both murine and epidemic typhus develop a rash; however, the rash associated with murine typhus develops early and is much less severe, according to Merck. Epidemic typhus causes small, pink, non-raised areas called macules to form on the skin approximately 4 to 6 days after signs of an intense headache and 104 degrees Fahrenheit fever begin--usually 7 to 14 days after infection. These macules spread to the armpits and upper trunk, but not to the face, palms of the hand or soles of the feet. The rash then progresses, becoming dark in color and comprised of macules and raised bumps called papules. In severe cases, the rash can turn purple because of hemorrhaging beneath the skin.
Other Common Symptoms
Individuals with both murine and epidemic typhus may experience joint pain and a dry or hacking cough. Those with murine typhus are also likely to experience symptoms such as abdominal pain, a backache, nausea and vomiting.
Those with epidemic typhus may have chills and severe muscle pain, or myalgia. They may also develop photophobia--a condition in which lights appear very bright and hurt the eyes. Enlargement of the spleen, or splenomegaly, can also occur as a result of the infection. Epidemic typhus can also cause delirium, or a state of sudden and severe confusion that can cause disorientation about time or place, disorganized thinking and speech, changes in consciousness or alertness and extreme emotional and personality changes such as euphoria, depression, irritability or anger, according to the National Institutes of Health. Some people suffering from delirium may wander aimlessly, appear drowsy, inactive or slow-moving, and show deficits in short-term memory. Stupor--diminished consciousness, alertness or awareness--is also a sign of endemic typhus.
Poor Prognostic Symptoms
The National Institutes of Health note that between 10 and 60 percent of patients with epidemic typhus die from the disease. According to Merck, individuals with epidemic typhus may develop serious symptoms that suggest a poor prognosis. These symptoms can include pneumonia, low blood pressure, vascular collapse or shock due to decreased blood volume and circulation throughout the body and ecchymosis--the escape of blood from ruptured blood vessels into tissue beneath the skin. Ecchymosis may sometimes also cause gangrene or tissue death. Renal insufficiency, or poor kidney function often due to reduced blood flow to the kidneys, is another poor prognostic sign.
