Typhus

and Sabine Schrör, medical journalist

Mareike Müller is a freelance writer in the medical department and assistant doctor for neurosurgery in Düsseldorf. She studied human medicine in Magdeburg and gained a lot of practical medical experience during her stays abroad on four different continents.

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Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

Typhus is an infectious disease caused by bacteria. These are transmitted to humans through clothing lice. Typhus is extremely rare in Germany. Typical symptoms are a high fever that lasts for days and a rash. With timely treatment, typhus will heal without consequences. Here you can read everything you need to know about typhus.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A75A77

Typhus: description

The spotted fever (also called spotted louse or tick spotted fever) is an infectious disease caused by the bacterium Rickettsia prowazekii is caused. The germs are transmitted by blood-sucking clothes lice and tropical ticks.

Typhus from clothes lice

Typhus, transmitted by clothes lice, is very rare in Germany these days. Most recently, typhus epidemics occurred in Europe during the world wars. Because back then, people sometimes had to live under poor hygienic conditions, for example in refugee areas.

In some parts of the world, typhus is still more common today, such as in East Africa and the Andean valleys of South America. Crowds and poor hygienic conditions are risk factors for infection.

Tick ​​spotted fever

In the summer of 2019, the first case of tick spotted fever was detected in Germany. The tropical Hyalomma tick has also been spreading in this country for some time. The populations are still low, but at the end of July 2019 a horse owner from North Rhine-Westphalia fell ill with typhus after being bitten by a Hyalomma tick.

The Hyalomma tick originally comes from the arid and semi-arid regions of Africa, Asia and southern Europe. Their number is growing in Germany: While 35 tropical ticks were counted in 2018, there were already 50 identified specimens in 2019.

The tropical tick is relatively easy to distinguish from the most common type of tick in Germany - the common wood tick (Ixodes ricinus): The Hyalomma tick is around two centimeters long, and is much larger and also has noticeably striped legs.

Typhus should not be confused with typhus. Oral terms like "typhus" or "typhus" are misleading. Typhoid is an infectious disease caused by salmonella. Misunderstandings can also arise in the Anglo-Saxon language area. There typhus is called "typhus" or "typhus fever". Typhoid itself is called "typhoid fever" in English.

Typhus: symptoms

The time between infection and the outbreak of typhus (incubation period) is 10 to 14 days. The symptoms then set in quite suddenly: The main symptoms are flu-like symptoms, i.e. severe headaches, muscle and body aches and a pronounced feeling of illness or lethargy.

Typical symptoms of typhus are high fever and a rash. The fever is very characteristic: it rises quickly to 41 ° C in the first two days of illness, often accompanied by chills. It then lasts for at least ten days before the defever begins. This takes about four to five days.

On the fourth to seventh day of illness, typhus patients get a rash (exanthem). This begins on the trunk and quickly spreads to the extremities. The face as well as the palms and feet are left out. The rash is characterized by spots (macules) that show a colorful picture: some spots are crimson, others purple or pink. In addition, there is bleeding from the skin (petechiae).

Other symptoms seen with typhus include:

• Restlessness
• Trembling (tremor) of the hands
• Speech disorders
• Impaired consciousness
• Violence

Secondary infections

If you get typhus, you are susceptible to further infections (secondary infections). Among other things, typhus favors:

• Meningitis
• Inflammation of the lungs (pneumonia)
• Inflammation of the heart muscle (myocarditis)

Affected patients show signs of these diseases in addition to the typhus symptoms (e.g. stiff neck in meningitis).

Typhus: causes and risk factors

The typhus infection is triggered by the bacterium Rickettsia prowazekii. It can be transmitted to humans by infected lice and tropical ticks: the animals excrete the pathogens through their faeces. If you then scratch the lice bites or tick bites, the germs can get into the skin. There they multiply in the cells of small blood vessels, whereby these are destroyed. The bacteria then enter the bloodstream. In this way, they can spread throughout the body and repeatedly infect new blood vessel cells. The result is more and more damaged vessels. The tissue areas supplied by them can even die off (necrosis). Skin bleeding also occurs.

Clothes lice are very rare in Germany these days. That is why there are hardly any infections with the typhus bacterium caused by clothing lice in this country.

In contrast, the further spread of the tropical tick species Hyalomma could increase the typhus risk in Germany in the medium term. The stocks in this country are still low (see above). However, experts assume that around every second Hyalomma tick carries the typhus pathogen.

A direct infection from person to person is not possible with typhus.

Typhus: examinations and diagnosis

In order to be able to diagnose typhus if you have a suspicious fever or rash, the doctor first needs more detailed information about your medical history (anamnesis). He will ask you the following questions, among others:

• Have you been to Africa or South America lately?
• Have you noticed lice on yourself or on your clothes?
• Have you recently been bitten by a tick?
• How long have you had the fever?
• Where did the rash start and how did it develop?

To detect a typhus infection, there is a blood test. Specific antibodies that the body has formed against the rickettsiae are searched for. This test should be carried out by experienced specialist laboratories.

In the past, tissue samples were taken from patients and examined directly for the pathogen. As a rule, this is no longer done nowadays, as the testing of tissue samples is unreliable and is associated with an increased risk of infection.

In order to be able to diagnose typhus fever with certainty, the doctor must rule out other diseases that cause similar symptoms. These include:

• Meningococcal infections
• Typhoid fever (Typhus abdominalis)
• Haemorrhagic febrile diseases
• Relapsing fever

If the diagnosis of typhus has been established, the doctor must inform the responsible health department about it - typhus is notifiable in Germany.

Typhus: treatment

Typhus is mainly treated with antibiotics, for example tetracyclines or chloramphenicol. Quinolones and rifampicin can also be used. In addition, the anti-malarial agent chloroquine can be given to increase the effectiveness of the other antibiotics.

It is also important to ensure that patients have a balanced fluid and electrolyte balance. Possible secondary infections (additional illnesses caused by other pathogens) must also be treated with appropriate agents.

Typhus: disease course and prognosis

Typhus is a serious infectious disease that, if left untreated, is fatal in up to 40 percent of cases. However, if it is treated in good time, the prognosis is good: Typically, typhus heals completely and without consequences after antibiotic treatment.

However, it can take a few months for those affected to recover completely. The healing time is significantly increased, especially due to malnutrition or a restricted function of the immune system.

In some cases, the typhus pathogens stay in the body for up to 30 years. Normally they do not trigger a new disease during this time, as they are kept in check by the body's own defense system. If symptoms break out anyway, this is referred to as Brill-Zinser disease. It is much shorter and milder than typhus.

Typhus: prevention

On the one hand, typhus can be prevented by combating the clothes lice as a disease carrier. Here, for example, insecticides have proven their worth. In addition, when traveling to risk areas, you should ensure adequate hygiene and do not wear unwashed clothes.

On the other hand, the prevention of typhus includes protection against tick bites. In designated tick areas you should therefore wear long clothes (long pants, long sleeves) when you are out and about in nature. After returning home, you should check your body thoroughly for ticks. If you discover a blood-sucking tick on the skin, it is important to remove it correctly.

There is currently no vaccine available against typhus. In special cases, for example in humanitarian operations in risk areas, prophylaxis with medication is possible. The antibiotic doxycycline is administered once for this purpose. Even in such cases, the best prevention of typhus is to avoid contact with clothes lice and ticks as much as possible.

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