Epidemic and murine typhus disease have common clinical manifestations. History of the patient may show many indicative features like occupational exposure, visit to endemic areas, overcrowding, or poor hygiene. War or civil unrest are found to be common risk factors in the development of rickettsiae infection. In epidemic typhus, the symptoms may be present in different systems. Fever and headache are the initial symptoms. In epidemic typhus a petechial rash may develop in the axilla 4-5 days after infection. The rashes may gradually spread to the trunk.
In scrub typhus disease, a small and painless papule develop at the site of mite bite. This may undergo necrosis and result in the formation of an eschar. Eschar is a confirmatory symptom in the case of scrub typhus. Eschar formation may be absent in around 40% of the patients and this makes diagnosis hard. Many other symptoms of this disease are non-specific. Localized lymphadenopathy is noted at the site of bite and this may develop into generalized lymphadenopathy. Pulmonary involvement is often noted in scrub typhus and hence patients may present with tachypnea and cough. Conjunctival suffusion also may be noted in some of them.
When left untreated, fever may be persistent and can be associated with relative bradycardia. Fever may persist for 2-3 days even after the start of antibiotic treatment. Maculopapular rashes spread from the axilla to the trunk and then to different parts of the body, except face, sole, and palms.

• Splenomegaly

  RESULTS: The most common CT finding was hepatomegaly (74.4%), followed by splenomegaly (66.7%). The majority of patients had at least three areas of abdominopelvic lymphadenopathy (71.8%). [ncbi.nlm.nih.gov]

  Splenomegaly is observed in 1/3 of cases. Most cases are mild, but pneumonitis, meningoencephalitis, multiorgan failure, bleeding and even death may occur, especially in untreated patients. [orpha.net]

• Generalized Lymphadenopathy

  Abstract Scrub typhus is an acute infectious disease caused by Orienta tsutsugamushi, which is clinically manifested by fever, generalized lymphadenopathy, diffuse myalgia, headache, maculopapular rash, and eschars at the site of chigger feedings. [ncbi.nlm.nih.gov]

  Localized lymphadenopathy is noted at the site of bite and this may develop into generalized lymphadenopathy. Pulmonary involvement is often noted in scrub typhus and hence patients may present with tachypnea and cough. [symptoma.com]

• Fever

  Typhus fevers are a group of diseases caused by bacteria that are spread to humans by fleas, lice, and chiggers. Typhus fevers include scrub typhus, murine typhus, and epidemic typhus. [web.archive.org]

  These forms of spotted fever occur only rarely and affect patients who had spotted fever during the war years. [doi.org]

  MESSAGE: In unexplained prolonged fever or atypical clinical manifestations not explainable by the primary disease process, co-infection needs to be considered. [ncbi.nlm.nih.gov]

  Typhus was also a significant killer during the US Civil War, although typhoid fever was the more prevalent cause of US Civil War "camp fever". [en.wikipedia.org]

  ‘The body louse, Pediculus humanus corporis, is a vector of epidemic typhus, trench fever, and relapsing fever.’ [en.oxforddictionaries.com]

• Chills

  * It is a rickettsial disease with variable onset, but is often characterised by the sudden appearance of headaches, chills, prostration, high fever, coughing and severe muscular pain. [web.archive.org]

  Symptoms include chills, headache and fever, lasting about 12 days. Rash and other manifestations are similar to epidemic typhus. [thirdworldtraveler.com]

  Other frequent symptoms were chills, malaise, myalgia, and anorexia. A tetrad of reported laboratory abnormalities consisting of elevated liver enzymes, lactate dehydrogenase, erythrocyte sedimentation rate and hypoalbuminemia was detected. [ncbi.nlm.nih.gov]

  Synonyms: typhus fever Types: endemic typhus, murine typhus, rat typhus, urban typhus acute infection caused by rickettsia and transmitted by the bite of an infected flea; characterized by fever and chills and muscle aches and a rash Type of: rickettsial [vocabulary.com]

  […] tenderness, agitation, bloody stool, chills, confusion, delirium, hallucinations, nose bleeds and fatigue. [passporthealthusa.com]

• High Fever

  […] ty·phus | \ ˈtī-fəs \ : any of various bacterial diseases caused by rickettsias: such as a : a severe human febrile disease that is caused by one ( Rickettsia prowazekii ) transmitted especially by body lice and is marked by high fever, stupor alternating [merriam-webster.com]

  * It is a rickettsial disease with variable onset, but is often characterised by the sudden appearance of headaches, chills, prostration, high fever, coughing and severe muscular pain. [web.archive.org]

  CASE PRESENTATION: A 62-year-old previously healthy Sri Lankan native male from the Western province of Sri Lanka presented with high fever with malaise, myalgia and arthralgia for 17 days. [ncbi.nlm.nih.gov]

  Symptoms are prolonged high fever, intractable headache, and a maculopapular rash. Epidemic typhus is a rickettsial disease. [merckmanuals.com]

• Malaise

  We report a previously healthy 74-year-old Thai female farmer who presented in Nakhon Ratchasima, Thailand, with a history of fever and malaise for 5 days, followed by abdominal pain for 1 day. [ncbi.nlm.nih.gov]

• Gangrene

  A 10-y-old male child from Delhi presented with fever, non specific gastrointestinal symptoms, petechial rash and gangrene of all the toes. [ncbi.nlm.nih.gov]

  Vascular collapse, renal insufficiency, encephalitic signs, ecchymosis with gangrene, and pneumonia are poor prognostic signs. [merckmanuals.com]

  Patients with severe epidemic typhus may develop gangrene, leading to a loss of digits, limbs, or other appendages. [emedicine.com]

  Patients with severe form of epidemic typhus may develop gangrene that leads to loss of limb or other appendages. Vasculitis may also result in neurological symptoms, multiorgan failure, and even death. [symptoma.com]

• Cough

  Despite such an extensive consolidation, respiratory symptoms such as cough and breathlessness were inconspicuous thereby posing a diagnostic dilemma. [ncbi.nlm.nih.gov]

  ‘Tito's government significantly raised the standard of health, eliminating diseases such as typhus, tuberculosis, and whooping cough.’ [en.oxforddictionaries.com]

  Murine typhus is known to cause abdominal pain, backaches, rashes on the mid body, fevers up to 106 degrees, dry coughs, nausea, headaches, and joint pain. [study.com]

  Joint and muscle pain Nausea and vomiting Symptoms of epidemic typhus may include: High fever, chills Confusion, decreased alertness, delirium Cough Severe muscle and joint pain Lights that appear very bright; light may hurt the eyes Low blood pressure [nlm.nih.gov]

• Dry Cough

  Murine typhus is known to cause abdominal pain, backaches, rashes on the mid body, fevers up to 106 degrees, dry coughs, nausea, headaches, and joint pain. [study.com]

  Symptoms of murine or endemic typhus may include: Abdominal pain Backache Dull red rash that begins on the middle of the body and spreads Fever, can be extremely high, 105°F to 106°F (40.6°C to 41.1°C), that may last up to 2 weeks Hacking, dry cough Headache [nlm.nih.gov]

  […] arthalgia myalgia photophobia delirium murine or endemic typhus abdominal pain diarrhea backache headache extremely high fever (105-106 F) may last for up to two weeks dull, red rash begins on the trunk and spreads peripherally hacking, dry cough arthralgia [step2.medbullets.com]

• Nausea

  Typical gastrointestinal manifestations in patients with scrub typhus include abdominal pain, nausea, vomiting, hematemesis, melena, and diarrhea. [ncbi.nlm.nih.gov]

  Disease onset is often sudden, and symptoms may include fever, headache, chills, weakness, nausea/vomiting, body aches, and rash. [dshs.state.tx.us]

  Symptoms Symptoms of typhus appear after an incubation period of two weeks and are as follows: a high fever; rash convering most of the body; headache ; chills; widespread pain; stupor, i.e. immobility and muteness; delirium ; coughing; nausea and vomiting [health.ccm.net]

  Signs and symptoms may include: Fever and chills Headache Rapid breathing Body and muscle aches Rash Cough Nausea Vomiting Confusion Brill-Zinsser disease Some people can remain infected, without symptoms, for years after they first get sick. [cdc.gov]

• Vomiting

  Associated clinical features like pain abdomen, vomiting, and features of third space losses made us suspect a co-infection. IgM and IgG antibodies by ELISA in acute and convalescent serum were suggestive of scrub typhus. [ncbi.nlm.nih.gov]

• Abdominal Pain

  The second patient also presented to the hospital with a 1 week history of fever and upper quadrant abdominal pain. She was diagnosed with having cholecystitis. [ncbi.nlm.nih.gov]

• Diarrhea

  Typical gastrointestinal manifestations in patients with scrub typhus include abdominal pain, nausea, vomiting, hematemesis, melena, and diarrhea. [ncbi.nlm.nih.gov]

  […] including sudden-onset fever (104 F) chills severe headache maculopapular rash appears 5-9 days after onset of symptoms spreads peripherally from trunk to extremities cough arthalgia myalgia photophobia delirium murine or endemic typhus abdominal pain diarrhea [step2.medbullets.com]

• Loss of Appetite

  Signs and symptoms may include: Fever and chills Body aches and muscle pain Loss of appetite Nausea Vomiting Stomach pain Cough Rash (typically occurs around day 5 of illness) Most people will recover without treatment, but some cases may be severe. [web.archive.org]

  About 10 days after being bitten, an infected person experiences headache, loss of appetite, malaise, and a rapid rise in temperature with fever, chills, marked prostration, and nausea. [britannica.com]

• Hypotension

  […] or endemic typhus abdominal pain diarrhea backache headache extremely high fever (105-106 F) may last for up to two weeks dull, red rash begins on the trunk and spreads peripherally hacking, dry cough arthralgia myalgia nausea vomiting Physical exam hypotension [step2.medbullets.com]

  Hypotension occurs in most seriously ill patients. Vascular collapse, renal insufficiency, encephalitic signs, ecchymosis with gangrene, and pneumonia are poor prognostic signs. [merckmanuals.com]

  […] fever chills rash Symptoms of epidemic typhus usually appear suddenly and include: severe headache high fever (above 102.2°F) rash that begins on the back or chest and spreads confusion stupor and seeming out of touch with reality low blood pressure (hypotension [healthline.com]

• Jaundice

  BACKGROUND: Most common cause of jaundice in south east Asia is of infective etiology. Combination of fever with jaundice can cause diagnostic problem as this duo is present in many infective diseases. [ncbi.nlm.nih.gov]

  Of 44 patients hospitalized at Badanah Base Hospital, 3 developed jaundice and 2 died. The cause of one of these deaths was believed to be myocardial infarction. The cause of death of the second patient was not determined. [doi.org]

  ‘The animals harbor the lice and fleas that spawn serious diseases such as typhus, trichinosis, and infectious jaundice.’ [en.oxforddictionaries.com]

• Hepatomegaly

  RESULTS: The most common CT finding was hepatomegaly (74.4%), followed by splenomegaly (66.7%). The majority of patients had at least three areas of abdominopelvic lymphadenopathy (71.8%). [ncbi.nlm.nih.gov]

• Hearing Impairment

  There was no associated hearing impairment, seizures, or altered level of consciousness. There were no symptoms to suggest involvement of cerebellar system or autonomic nervous system. There was no family history of movement disorders. [bmcresnotes.biomedcentral.com]

• Myalgia

  KEYWORDS: Bhutan; Orientia tsutsugamushi eschar; chigger; conjunctival congestion; encephalitis/meningitis; eschar; larval mite; lymphadenitis; meningoencephalitis; myalgia; parasites; pediatric; rash; scrub typhus; thrombocytopenia; tsutsugamushi triangle [ncbi.nlm.nih.gov]

• Arthralgia

  Here one such case of a 55-year-old man is reported who presented with fever and arthralgia. There was an erythematous maculopapular rash on his body. One enlarged lymph node in the right axilla and hepatomegaly were elicited. [ncbi.nlm.nih.gov]

  Symptoms had started 8 days prior to hospitalization with fever, asthenia, arthralgia, and headache. Four days after the onset of symptoms she had developed a generalized maculopapular skin rash. [doi.org]

  […] cough arthalgia myalgia photophobia delirium murine or endemic typhus abdominal pain diarrhea backache headache extremely high fever (105-106 F) may last for up to two weeks dull, red rash begins on the trunk and spreads peripherally hacking, dry cough arthralgia [step2.medbullets.com]

• Skin Rash

  Possibility of rickettsial infection should be entertained in children with history of fever and skin rash, especially if the child fails to improve with a course of antibiotics and common infectious etiologies have been ruled out. [ncbi.nlm.nih.gov]

  […] typhus fever rickettsial disease transmitted by body lice and characterized by skin rash and high fever typhoid fever serious infection marked by intestinal inflammation and ulceration; caused by Salmonella typhosa ingested with food or water Texas fever [vocabulary.com]

• Eruptions

  A macular eruption (dark spot on the skin) appears on the fifth to sixth day, initially on the upper trunk, which then spreads to the entire body excepting, usually, the face, palms and soles of the feet. [web.archive.org]

  After approximately six days, red eruptions appear on the torso, hands, feet, and face. Mortality is incredibly high under epidemic conditions, nearing 100%. Epidemic typhus victim with characteristic eruptions on torso, neck, and arms. [montana.edu]

  After 5–6 days, a macular skin eruption (dark spots) develops first on the upper trunk and spreads to the rest of the body but usually not to the face, palms of the hands or soles of the feet. [who.int]

  It typically begins as a maculopapular eruption on the trunk of the body and spreads to the extremities, usually sparing the palms of hands and soles of feet. When the disease is severe, petechiae may develop. [cdc.gov]

• Petechiae

  […] rash begins on the trunk and spreads peripherally hacking, dry cough arthralgia myalgia nausea vomiting Physical exam hypotension fever photophobia early rash light rose color and blanches under pressure late rash dull red that does not fade scattered petechiae [step2.medbullets.com]

  Petechiae are uncommon. Physician Diagnosis It is important to treat scrub typhus early in the course of the disease in order to avert life-threatening complications. [cdc.gov]

• Alopecia

  Because these ticks often suck blood on the hairy scalp, localized alopecia in patients has been reported in some cases. [doi.org]

• Pruritic Rash

  Two weeks earlier, she had noticed a transient pruritic rash on her abdomen, which had appeared after she had been collecting firewood in a local forest clearing. [nejm.org]

• Headache

  The most common symptoms are fever, headaches, and sometimes rash. Clinical Guidelines Diagnosis and management of Typhus fevers Murine Typhus Bacterial disease spread by fleas Scrub Typhus Spread by chiggers in Southeast Asia [web.archive.org]

  The disease is characterized by high fever, intractable headache, and rash. Temperature reaches 104° F in several days and remains high. Headache is generalized and intense. On the 4th to 6th day, the rash develops and spreads. [thirdworldtraveler.com]

  Abstract Scrub typhus is an acute infectious disease caused by Orienta tsutsugamushi, which is clinically manifested by fever, generalized lymphadenopathy, diffuse myalgia, headache, maculopapular rash, and eschars at the site of chigger feedings. [ncbi.nlm.nih.gov]

  Murine typhus is known to cause abdominal pain, backaches, rashes on the mid body, fevers up to 106 degrees, dry coughs, nausea, headaches, and joint pain. [study.com]

• Confusion

  […] tenderness, agitation, bloody stool, chills, confusion, delirium, hallucinations, nose bleeds and fatigue. [passporthealthusa.com]

  Signs and symptoms may include: Fever and chills Headache Rapid breathing Body and muscle aches Rash Cough Nausea Vomiting Confusion Brill-Zinsser disease Some people can remain infected, without symptoms, for years after they first get sick. [cdc.gov]

  If a European soccer fan were to come to an NFL, NBA or MLB game, they would be genuinely confused by the atmosphere. [one37pm.com]

• Altered Mental Status

  Typical signs and symptoms include: Fever and chills Headache Myalgia Eschar Altered mental status, ranging from confusion to coma or delirium Lymphadenopathy Rash Most patients have thrombocytopenia and may also show elevated levels of liver enzymes, [cdc.gov]

  Other signs of meningoencephalitis include sensitivity to light (photophobia), altered mental status (delirium), or coma. Untreated cases are often fatal. Multiple diseases include the word "typhus" in their descriptions. [en.wikipedia.org]

• Agitation

  * Warning signals: Louse-borne typhus should be suspected when people in crowded, louse-infected conditions experience sudden onset of high fever, chills, headaches, general pain and severe exhaustion alternating with agitation, followed on the fifth [web.archive.org]

  […] similarity, and why many have thought them to be the same disease for so long, is the symptoms: Typhus: Abdominal pain, rash, high fever, cough, headache, joint and muscle pain, nausea, chills, confusion and low blood pressure Typhoid: Abdominal tenderness, agitation [passporthealthusa.com]

  —I have an idea that agitation does it as much harm as fatigue” (8 September 1816); “I am almost entirely cured of my rheumatism; just a little pain in my knee now & then” (20 February 1817); “I have still a tendency to Rheumatism” (26 March 1817). [jasna.org]

• Tremor

  Clinical examination revealed a high amplitude low frequency resting tremor in his right hand, a mask-like face and increased muscle tone limited to the right side with normal reflexes. [ncbi.nlm.nih.gov]

  Around the 5th day of the clinical illness he had developed intermittent resting tremor in his right arm and leg. By the time he presented to us he had stiffness and very frequent intermittent resting tremor (Additional file 1 : Video). [bmcresnotes.biomedcentral.com]

History of the patient with characteristic symptoms of the disease are very important in the diagnosis of typhus disease. Laboratory studies are more helpful in assessing the severity of the condition rather than confirmatory diagnosis of typhus disease. It also helps in differential diagnosis. Laboratory studies are useful in assessing the vasculitic changes caused by the infection. Some of the common abnormalities noted include proteinuria, leukopenia, thrombocytopenia, higher levels of transaminase, and hypoalbuminemia.
Acute primary disease is diagnosed using immunofluorescence assay (IFA) or enzyme immunoassay which may show an increase in IgM titer. Brill-Zinsser disease is confirmed with a history of primary epidemic typhus disease with an increase in antibody titer and also recurrent symptoms of typhus. The increase in the levels of IgM indicates secondary response. Biopsy and PCR helps in confirmatory diagnosis of the disease [9]. Complement fixation test is useful in identifying the causative species of rickiettsiae. Chest radiography is used to assess the course of scrub typhus and is usually done one week after the onset of symptoms [10].

• Leukopenia

  Some of the common abnormalities noted include proteinuria, leukopenia, thrombocytopenia, higher levels of transaminase, and hypoalbuminemia. [symptoma.com]

  Ehrlichiosis and anaplasmosis should be suspected in febrile patients with leukopenia and thrombocytopenia and mild to moderately elevated levels of hepatic transaminases. DIAGNOSIS Diagnosis is usually based on clinical recognition and serology. [wwwnc.cdc.gov]

  Patients typically present with fever and headache or fever and rash and may also experience: Myalgia Anorexia Nausea Vomiting Abdominal pain Cough Altered mental status Common laboratory findings may include anemia, thrombocytopenia, leukopenia, hyponatremia [cdc.gov]

• Salmonella Typhi

  The antibiotic-resistant strain of Salmonella Typhi, the primary cause of typhoid, emerged within the last 30 years and may represent an ongoing, previously unrecognized epidemic in Africa, reports a study published online this week in Nature Genetics [natureasia.com]

  Both diseases contain the word ‘typhi’ in their official names. Rickettsia typhi is the proper name of typhus and it’s Salmonella typhi for typhoid. [passporthealthusa.com]

Antibiotics are the standard of care in the treatment of the disorder [11]. Doxycycline and chloramphenicol are used as antirickettsial agents.

Prognosis of the disease often depends on the severity of the disease and also the health of the patient at the time of infection. More severe form of clinical features are seen with epidemic typhus. Patients with severe form of epidemic typhus may develop gangrene that leads to loss of limb or other appendages. Vasculitis may also result in neurological symptoms, multiorgan failure, and even death. Early diagnosis and treatment are good prognostic factors for any type of typhus disease. Starting antibiotic therapy as early as possible helps to improve the symptoms and to reduce mortality.

Typhus is caused by pleomorphic bacteria belonging to the group of rickettsiae. These are obligate intracellular parasites and may be cocci or bacilli in form. Epidemic typhus is caused by Rickettsia prowazekii [1]. Body louse is the vector for this form of typhus fever, commonly Pediculus corporis, P capitis, and Phthirus pubis. Occasionally, flying squirrels are also found to harbor these bacteria [2]. Bacteria gains access into a louse when the louse feeds on the blood of an infected person. The louse often dies of rickettsiae infection caused by obstruction of alimentary canal.
Brill-Zinsser disease is a recrudescent form of epidemic typhus. If the patient gets lice infestation at the same time, the louse may become infested by feeding and may result in an outbreak of the disease [3].
Murine typhus is transmitted by cat or rat flea and is caused by R typhi. Fleas Xenopsylla cheopis (rat flea), and Ctenocephalides felis (cat flea), well known to act as vectors for R typhi. Usual hosts for the bacteria are mice and cat. These fleas are not usually affected by the infection, unlike lice in epidemic typhus. Aerosol contaminated with fecal matter of fleas is a possible route of infection.
Scrub typhus is caused by the species Orientia tsutsugamushi spread through mites. The common vectors of these bacteria are Leptotrombidium akamushi and Leptotrombidium delicense. Mites are not affected by the presence of bacteria [4]. Mammals like rats and mice are the usual hosts of the bacteria. Human beings are accidental hosts. The intracellular parasites are transmitted to the hosts during feeding. Many behavioral factors were found to be associated with increased risk of developing scrub typhus [5]. Some of them include taking rest near scrubs, working with bare hands, wearing short-sleeved dresses, and squatting.

Epidemic typhus is more prevalent in Central and South America, Africa, the northern parts of China, and the central regions of Himalayas. About 15% of the people who have a history of typhus may develop Brill-Zinsser disease at a later stage. It may occur up to 40 years after the initial typhus infections. When conditions for transmission and propagation of the vector are conducive, epidemic typhus outbreaks occur. It is often associated with wars and other conditions that lead to poor hygiene that favor infestation of lice. This disease is often found in cold regions, poverty, and during civil unrest. Men and women are equally affected by this disease [3]. Incomplete and inappropriate treatment of infection may increase the risk of recurrence, mostly in the form of Brill-Zinsser disease.
Murine typhus is more common in the coastal areas of subtropical and temperate countries. It is endemic in many areas and is mostly sporadic in nature. In temperate climates the population of fleas increase during summer months, thus increasing the incidence of the disease. Homeless people are at an increased risk of developing this form of typhus [6].
Northern Australia, Indian subcontinent and Pacific regions are more susceptible to scrub typhus. Many endemic areas of this disease lack appropriate diagnostic facilities, a condition which results in a serious underestimation of the incidence. In Malaysia, the incidence of scrub typhus was about 3% in a month. Multiple infections were found in the same individual indicating absence of cross immunity [7].
In general, typhus infections occur equally among males and females. Furthermore, there is no age predilection for the occurrence of this disease, even though in United States murine and epidemic typhus are found to be more common among adults [8].

Louse bite causes a pruritic reaction on the skin. Scratching of the site crushes the lice, and fecal matter containing the bacteria enters the wound. Rickettsia then moves to the blood stream where it parasitizes the endothelial cells of blood vessels. Incubation period for the pathogen is about 12 days. These bacteria then proliferate in the cells resulting in cell enlargement and multiorgan vasculitis. Deposition of leukocytes, macrophages and platelets occurs in the affected area resulting in small nodules. Proliferation of the bacteria may also result in thrombosis leading to gangrene in the extremities. Vasculitis is the reason for intravascular colloid loss, hypovolemia and reduced tissue perfusion. It may also lead to organ failure.
Some of the people who have suffered from a Rickettsia infection may develop recrudescent typhus, the Brill-Zinsser disease. Even after successful treatment of the infection, the bacteria may remain in the tissues. After several months, or even years, this bacteria may become active resulting in recurrence of typhus. The method by which the pathogen remains inactive and silent is not clearly known. The manifestations of Brill-Zinsser disease are less severe than the actual infection. Pathophysiology of murine and scrub typhus disease are similar to that of epidemic typhus.

Louse-borne infections can be prevented by de-lousing clothes and maintaining good personal hygiene. Avoiding contact with ticks and mites help in preventing diseases caused by them. Control of vectors and animal reservoirs are also helpful. Arthropod vectors can be controlled by the use of insecticides. Reducing rodent population, wearing protective clothing and avoiding overcrowding help in preventing the spread of the disease. Try to avoid exposure to areas endemic to the particular type of typhus disease.

Typhus is a group of infectious diseases caused by rickettsial species. This disease result in acute febrile illness and is transmitted by arthropod vectors like lice, mites and fleas. The most common among them are :

• Epidemic typhus
• Brill-Zinsser disease
• Murine typhus
• Scrub typhus

Epidemic typhus is a major threat to public health, particularly during war or a civil unrest. Brill-Zinsser disease is a mild form of recurrent epidemic typhus and is more prevalent among elderly people. Murine typhus is rat flea-borne and is more common in Southern United States, particularly in summer and fall. Clinical manifestations of murine typhus are similar to that of epidemic typhus, but are less severe. Both epidemic and murine typhus infections render the patient immune to subsequent infections. Scrub typhus is mite-borne and is more commonly found in Asia-Pacific region.

Typhus is a group of infectious diseases caused by by Rickettsia bacteria. This disease result in acute febrile illness and is transmitted by vectors like lice, mites and fleas. The most common among them are :

• Epidemic typhus
• Brill-Zinsser disease
• Murine typhus
• Scrub typhus

The signs and symptoms depend on the form of the disease. Antibiotics are the standard of care in the treatment of typhus.

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5. Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, et al. A community-based case-control study of behavioral factors associated with scrub typhus during the autumn epidemic season in South Korea. Am J Trop Med Hyg. 2009;80(3):442-446.
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10. Chen HC, Chang HC, Chang YC, Liu SF, Su MC, Huang KT, et al. Chest radiographic presentation in patients with scrub typhus. Trans R Soc Trop Med Hyg. 2011; 106(1):48-53. 
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