Typhus natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Rickettsioses range in severity from diseases that are usually relatively mild (rickettsialpox, cat scratch disease, and African tick-bite fever) to those that can be life-threatening (epidemic and murine typhus, Rocky Mountain spotted fever, scrub typhus and Oroya fever), and they vary in duration from those that can be self-limiting to chronic (Q fever and bartonelloses) or recrudescent (Brill-Zinsser disease). Without treatment, fever may last 2 weeks, followed by a prolonged recovery time and a significantly greater chance of developing complications. Possible complications include renal insufficiency, pneumonia, central nervous system damage.

Natural History, Complications and Prognosis

Natural History

• The clinical severity and duration of illnesses associated with different rickettsial infections vary considerably, even within a given antigenic group.
• Rickettsioses range in severity from diseases that are usually relatively mild (rickettsialpox, cat scratch disease, and African tick-bite fever) to those that can be life-threatening (epidemic and murine typhus, Rocky Mountain spotted fever, scrub typhus and Oroya fever), and they vary in duration from those that can be self-limiting to chronic (Q fever and bartonelloses) or recrudescent (Brill-Zinsser disease).
• Without treatment, fever may last 2 weeks, followed by a prolonged recovery time and a significantly greater chance of developing complications.
• Delay in treatment may result in advanced disease, including neurologic manifestations such as confusion, seizures, or coma, and widespread vasculitis (damage to the endothelial cells that line blood vessels).

Complications

Possible complications include:

• Renal insufficiency
• Pneumonia
• Hearing loss
• Myocarditis
• Vasculitis
• Aseptic meningitis

Prognosis

Without treatment, death may occur in 10 - 60% of patients with epidemic typhus. Patients over age 60 have the highest risk of death. Patients who receive treatment quickly should completely recover. Less than 2% of untreated patients with murine typhus may die. Most patients with rickettsial infections recover with timely use of appropriate antibiotic therapy