Typhus: what it is, symptoms, causes, treatment and how it differs from typhoid

The NHS describes typhus as an infection spread by lice, fleas or mites. A UK-authored professional article on Patient.info describes it as an acute febrile illness caused by rickettsial bacteria, acquired from lice and fleas from other humans and small mammals such as rats, cats and squirrels, most commonly rats.

The NHS calls it very rare in the UK; nidirect says it is found in many countries but is very rare in Northern Ireland. In practice UK doctors mostly meet it in people who have recently travelled.

It is sometimes confused with typhoid, but they are unrelated infections. The table below summarises the difference.

The NHS lists a high temperature, headache, a rash that may be harder to see on black or brown skin, feeling or being sick and feeling generally unwell. nidirect gives a longer list: a very high temperature, usually around 40C, nausea, vomiting and diarrhoea, a dry cough, tummy pain, joint pain, backache and a dark spotty rash on the chest that may spread to the rest of the body apart from the face, palms and soles.

The Patient.info professional article gives an incubation period of 10 to 14 days for epidemic typhus, with symptoms lasting around two weeks and the rash usually appearing 4 to 7 days into the illness. For endemic typhus it gives an incubation of 1 to 2 weeks, with an average of 12 days. Severe cases can involve confusion, low blood pressure and shock.

• A very high temperature, often around 40C

• Severe headache

• A dark spotty rash that starts on the chest and spares the face, palms and soles

• Nausea, vomiting and diarrhoea

• Dry cough, tummy pain, joint pain and backache

• Confusion and drowsiness in severe cases

Patient.info's professional article (archived, last updated 2019) separates typhus into two major types and a closely related illness, scrub typhus, each with a different carrier and severity.

The NHS says if a doctor thinks you could have typhus they will usually suggest a blood test or skin biopsy. Antibiotics are used to treat the infection and are usually started before you get your test result, as this can take up to a week. Most people start to feel better within 48 hours of starting treatment. It is important to keep taking your antibiotics until they are finished, even if you feel better, and people with severe typhus may need to be treated in hospital.

The Patient.info professional article says doxycycline or tetracycline are used when the disease is suspected, that most patients improve dramatically within 48 hours, and that treatment is often continued for 2 to 4 days after fever has subsided. Patients with epidemic typhus may need intravenous antibiotics and oxygen.

Typhus does not spread like a cold. The NHS says you catch it from bites of infected lice, mites or fleas, and that people can carry them on their clothes, skin or hair. Person-to-person spread happens through body lice. The Patient.info professional article says epidemic typhus outbreaks occur where poverty, homelessness, close human contact and lack of washing facilities favour the spread of the human body louse.

The NHS advises not wearing clothing or using bedding that might be infected with body lice, and washing and changing clothes regularly. The article also says typhus is notifiable in the UK, so doctors report cases to public health teams.

The NHS says there is no vaccine to prevent typhus, but you can reduce the risk of infection when travelling.

• Use insect repellent that contains DEET

• Wear long-sleeved shirts and trousers

• Wash and shower regularly, and wash and change clothes regularly

• Do not wear clothing or use bedding that might be infected with body lice

• Avoid overcrowded places such as travel hostels where there may be lice or fleas, if possible

• Avoid going near animals such as mice, rats, cats and squirrels

• Speak to your GP before travelling to an area where typhus is a problem

The NHS says to get medical advice if you have symptoms of typhus and you have recently returned from abroad, or you are travelling abroad. In England, see a GP, call 111 or use 111 online; if you are abroad, check your travel insurance for how to get medical help or check country health advice on GOV.UK. It is important to be diagnosed early, so treatment can start as soon as possible, as untreated typhus can sometimes be life-threatening.

Call 999 or go to A&E if someone with a recent travel history has confusion, difficulty breathing, collapse or a rapidly spreading rash with high fever.

Suspected typhus after travel is assessed through a GP, NHS 111 or hospital infectious disease or acute medical services, because treatment is usually started before test results and severe cases need admission. Because it is notifiable, public health teams are told of confirmed cases. Private travel clinics can advise on prevention before travel but there is no vaccine.