Epidemic Louse-Borne Typhus Fever

What is Epidemic Louse-Borne Typhus Fever?

Epidemic louse-borne typhus fever is one of three versions of the disease typhus, caused by three different bacteria in the Rickettsia genus, i.e, Rickettsia prowazekii, Rickettsia typhi, and Orientsia tsutsugamushi. Louse-borne typhus is caused by Rickettsia prowazekii. This disease usually occurs primarily in cold climates where human infestation with lice may occur and usually where groups of people are crowded together with poor sanitation and malnutrition. 

The risk for travellers of acquiring epidemic louse-borne typhus fever is low, however, this risk is increased for those who may live and work in remote areas (anthropologists, archeologists, geologists, medical personnel, missionaries).

How do you get Epidemic Louse-Borne Typhus Fever?

This disease is transmitted by infected body lice.  When the louse bites, it defecates, and the disease is then transmitted to an uninfected person who scratches the bite and rubs the feces into the wound.

Susceptibility and Resistance

All people are potentially susceptible to epidemic louse-borne typhus. However, prior infection creates long lasting immunity.

Incubation Period

The incubation period for Epidemic Louse-Borne Typhus Fever is 7-14 days.

What are the Symptoms?

Epidemic typhus may begin with the sudden onset of severe headache, aches, chills and fever. A skin rash often appears on the 5th or 6th day of illness, usually on the upper part of the body. The rash then spreads to all parts of the body, except the palms and soles. The fever usually subsides after 2 weeks. Other symptoms include cough, light sensitivity, and delirium. Mild infections may occur, especially in children.

The disease may reappear as a mild illness years after the first infection. This is known as Brill-Zinsser Disease, and people with this disease will transmit the bacteria to any lice that bite them, possibly causing new outbreaks.

Without treatment, 10-40 percent of people with epidemic louse-borne typhus fever will die. 

Preventative Measures

There is no vaccine or drug available to prevent epidemic typhus.  Avoiding lice infestation is the best way to prevent epidemic louse-borne typhus.  Avoid direct contact with anyone known to be infected with lice.  Avoid sharing their clothes, bedding, towels, and other personal items.  Bathe and change and wash clothes regularly.  Fumigation or dusting the environment with chemical insecticide may be required to eliminate lice from the area.  


A single dose of doxycycline (200 mg.) will usually cure patients.


Where Does It Commonly Occur?

The germs (Rickettsia) that cause epidemic typhus are transmitted by infected body lice. Therefore, this disease can occur anywhere that body lice are found, usually in colder climates when infested clothing is not laundered. The disease is most commonly found in the mountains of Mexico, in Central and South America, in parts of Africa and in many countries in Asia. Outbreaks of this disease are most common in homeless populations, refugee camps, and places that have experienced war or natural disasters.