Brill-Zinsser disease

Brill-Zinsser disease


Typhus is an infectious disease that is spread by lice or fleas.

Alternative Names

Murine typhus; Epidemic typhus; Endemic typhus; Brill-Zinsser disease; Jail fever


Typhus is caused by one of two types of bacteria: Rickettsia typhi and Rickettsia prowazekii.

The type of typus depends on which bacteria causes the infection.

Rickettsia typhi causes murine or endemic typhus. Endemic typhus is uncommon in the United States. It is usually seen in areas where hygiene is poor and the temperature is cold. Endemic typhus is sometimes called "jail fever." Lice and fleas of flying squirrels spread the bacteria.

Murine typhus occurs in the southeastern and southern United States. Murine typhus is rarely deadly. It is often seen in the summer and fall. Symptoms usually last 2 - 3 weeks. Risk factors for murine typhus include exposure to rat fleas or rat feces, or exposure to other animals (such as cats, opossums, raccoons, skunks, and rats).

Rickettsia prowazekii causes epidemic typhus and Brill-Zinsser disease. Brill-Zinsser disease is a mild form of epidemic typhus. It occurs when the disease re-activates in a person who was previously infected. It is more common in the elderly.


Symptoms of murine typhus may include:

  • Headache
  • Backache
  • Arthralgia
  • Extremely high fever (105 to 106 degrees Fahrenheit), which may last up to 2 weeks
  • Dull red rash that begins on middle of the body and spreads
  • Nausea
  • Vomiting
  • Hacking, dry cough
  • Abdominal pain

Symptoms of endemic typhus may include:

  • Severe headache
  • High fever (104 degrees Fahrenheit)
  • Cough
  • Arthralgia
  • Severe muscle pain ( myalgia)
  • Chills
  • Low blood pressure
  • Stupor
  • Delirium
  • Lights appear very bright; light may hurt the eyes
  • Rash that begins on chest and spreads to the rest of the body (except the palms of the hands and soles of the feet)

The early rash is a light rose color and fades when you press on it. Later, the rash becomes dull and red and does not fade. People with severe typhus may also develop petechiae.

Exams and Tests

A CBC may show anemia and low platelets. Other blood tests for typhus may show:

  • Low sodium level
  • Low level of albumin
  • Mildly high liver enzymes
  • Mild kidney failure
  • High level of typhus antibodies


Treatment includes antibiotics such as tetracycline, doxycycline, or chloramphenicol. Tetracycline taken by mouth can permanently stain teeth that are still forming. It is usually not prescribed for children until after all the permanent teeth have grown in.

Intravenous fluids and oxygen may be necessary for patients with epidemic typhus.

Outlook (Prognosis)

Without treatment, death may occur in 10 - 60% of patients with epidemic typhus. Patients over the age of 60 have the highest risk of death. When treatment is promptly received, the patient is expected to completely recover.

Less than 2% of untreated patients with murine typhus may die. Prompt antibiotic treatment will cure nearly all patients.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if symptoms of any type of typhus develop. This serious disorder can require emergency care.


Avoid areas where rat fleas or lice

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