eMedicine Specialties > Infectious Diseases > Bacterial Infections

Typhus: Differential Diagnoses & Workup

Author: Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center
Coauthor(s): Mark S Rasnake, MD, Assistant Professor of Medicine, Program Director, Internal Medicine Residency, University of Tennessee Graduate School of Medicine; Consulting Staff, Department of Infectious Diseases, University of Tennessee Medical Center at Knoxville; Eric A Hansen, DO, Fellow, Clinical Instructor, Department of Internal Medicine, Division of Infectious Diseases, Winthrop-University Hospital, State University of New York at Stony Brook; Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Contributor Information and Disclosures

Updated: Sep 18, 2008

Differential Diagnoses

Anthrax
Meningococcemia
Brucellosis
Relapsing Fever
Dengue Fever
Rocky Mountain Spotted Fever
Ehrlichiosis
Syphilis
Fever of Unknown Origin
Toxic Shock Syndrome
Infectious Mononucleosis
Toxoplasmosis
Kawasaki Disease
Tularemia
Leptospirosis
Typhoid Fever
Malaria
Meningitis

Other Problems to Be Considered

Rubella
Measles
Rickettsial diseases

Workup

Laboratory Studies

  • Laboratory studies are not particularly helpful in confirming a diagnosis of typhus. These studies assist the clinician in assessing the degree of severity of the illness and in helping exclude other diseases in the differential diagnoses.
  • The diagnosis of typhus is clinically suggested when the appropriate historical elements are elicited from a patient who presents with the characteristic symptoms and signs.
    • Antibiotic therapy should begin promptly when the diagnosis is suspected; thereafter, appropriate laboratory studies can be serially performed as needed.
    • Diagnosis may be confirmed using laboratory tests; however, more than one week may pass before patients mount a demonstrable immune response that can be measured serologically.
    • Laboratory confirmation of typhus is obtained irrespective of the clinical presentation.
  • Typhus is a vasculitic process that is capable of causing various abnormal laboratory values. Any organ may be affected, and multiorgan system dysfunction or failure may occur if the illness is not diagnosed and treated in the early stages. These abnormalities, listed by organ system, may include the following:
    • Renal - Azotemia/proteinuria
    • Hematologic
      • Leukopenia (common in the early stages of disease)
      • WBC count normal/mildly elevated later
      • Thrombocytopenia
    • Hepatic - Mild transaminase elevations
    • Metabolic - Hypoalbuminemia/electrolyte abnormalities (particularly hyponatremia)
  • Indirect immunofluorescence assay (IFA) or enzyme immunoassay (EIA) testing can be used to evaluate for a rise in the immunoglobulin M (IgM) antibody titer, which indicates an acute primary disease.
  • Brill-Zinsser disease can be confirmed in a patient with a history of primary epidemic typhus who has recurrent symptoms and signs of typhus and a rise in the immunoglobulin G (IgG) antibody titer, which indicates a secondary immune response.
  • IFA and EIA tests can be used to confirm a diagnosis of typhus, but they do not identify the various rickettsial species.
  • Polymerase chain reaction (PCR) amplification of rickettsial DNA of serum or skin biopsy specimens can be used for diagnosing typhus.
  • The complement fixation (CF) test is a serological test that can be used to demonstrate which specific rickettsial organism is causing disease by detection of specific antibodies.
  • Rapid diagnostic assays for scrub typhus, such as latex agglutination tests, are currently under development.5

Imaging Studies

  • No imaging studies are specifically indicated to aid in diagnosing typhus. Imaging studies are indicated only on a case-by-case basis to evaluate potential complications or as needed.

Histologic Findings

Rickettsia may be observed in tissue sections using Giemsa or Gimenez staining techniques.

More on Typhus

Overview: Typhus
Differential Diagnoses & Workup: Typhus
Treatment & Medication: Typhus
Follow-up: Typhus
References
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References

  1. Reynolds MG, Krebs JS, Comer JA, et al. Flying squirrel-associated typhus, United States. Emerg Infect Dis. Oct 2003;9(10):1341-3. [Medline].

  2. Boostrom A, Beier MS, Macaluso JA, et al. Geographic association of Rickettsia felis-infected opossums with human murine typhus, Texas. Emerg Infect Dis. Jun 2002;8(6):549-54. [Medline].

  3. Civen R, Ngo V. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis. Mar 15 2008;46(6):913-8. [Medline].

  4. Saah AJ. Orientia tsutsugamushi (Scrub typhus). In: Principles and Practice of Infectious Diseases. 2000:2056-2057.

  5. Wongchotigul V, Waicharoen S, Riengrod S, et al. Development and evaluation of a latex agglutination test for the rapid diagnosis of scrub typhus. Southeast Asian J Trop Med Public Health. Jan 2005;36(1):108-12. [Medline].

  6. Watt G, Kantipong P, Jongsakul K, et al. Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial. Lancet. Sep 23 2000;356(9235):1057-61. [Medline].

  7. Kim YS, Yun HJ, Shim SK, et al. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin Infect Dis. Nov 1 2004;39(9):1329-35. [Medline].

  8. Christie AB. Rickettsial disease: typhus. In: Infectious Diseases: Epidemiology and Clinical Practice. 2. 1987:1070-1097.

  9. Dumler JS, Walker DH. Rickettsia typhi (Murine typhus). In: Principles and Practice of Infectious Diseases. 2000:2053-55.

  10. Fergie JE, Purcell K, Wanat D. Murine typhus in South Texas children. Pediatr Infect Dis J. Jun 2000;19(6):535-8. [Medline].

  11. Higgins JA, Azad AF. Murine flea-borne typhus. In: Hunter GW, Thomas SG, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 8th ed. Philadelphia, Pa: WB Saunders and Co; 2000:434-5.

  12. La Scola B, Raoult D. Laboratory diagnosis of rickettsioses: current approaches to diagnosis of old and new rickettsial diseases. J Clin Microbiol. Nov 1997;35(11):2715-27. [Medline].

  13. Olson JG. Typhus: general principles. In: Hunter GW, Thomas SG, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 8th ed. Philadelphia, Pa: WB Saunders and Co; 2000:430-3.

  14. Raoult D, Roux V. Rickettsioses as paradigms of new or emerging infectious diseases. Clin Microbiol Rev. Oct 1997;10(4):694-719. [Medline].

  15. Saah AJ. Rickettsia prowazekii (epidemic or louse-borne typhus). In: Principles and Practice of Infectious Diseases. 2000:2050-2053.

  16. Watt G, Olson JG. Scrub typhus. In: Hunter GW, Thomas SG, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 8th ed. Philadelphia, Pa: WB Saunders and Co; 2000:443-5.

  17. Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. Oct 2003;16(5):429-36. [Medline].

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Further Reading

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Keywords

typhus, epidemic typhus, rickettsemia, louse-borne typhus, classic typhus, Brill-Zinsser disease, recrudescence of epidemic typhus, murine typhus, flea-borne typhus, endemic typhus, scrub typhus, tsutsugamushi fever, rickettsial infection, Pediculus corporis, Rickettsia prowazekii, R prowazekii, Rickettsia felis, R felis, Pediculus capitis, Phthirus pubis, Xenopsylla cheopis, Ctenocephalides felis, Leptotrombidium akamushi, Leptotrombidium deliense, Dermacentor andersoni, Dermacentor variabilis, Amblyomma americanum, Orientia tsutsugamushi, O tsutsugamushi, Rickettsia typhi, R typhi, Rickettsia tsutsugamushi, R tsutsugamushi, Rocky Mountain spotted fever, RMSF

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Contributor Information and Disclosures

Author

Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center
Jason F Okulicz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Mark S Rasnake, MD, Assistant Professor of Medicine, Program Director, Internal Medicine Residency, University of Tennessee Graduate School of Medicine; Consulting Staff, Department of Infectious Diseases, University of Tennessee Medical Center at Knoxville
Mark S Rasnake, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Eric A Hansen, DO, Fellow, Clinical Instructor, Department of Internal Medicine, Division of Infectious Diseases, Winthrop-University Hospital, State University of New York at Stony Brook
Eric A Hansen, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

John M Leedom, MD, Professor of Medicine, Keck School of Medicine, University of Southern California; Chief, Division of Infectious Diseases, Department of Internal Medicine, Los Angeles County, University of Southern California Medical Center
John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M Kerkering, MD, Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia
Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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