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Epidemic louse-borne typhus is a rickettsial bacterial disease that is transmitted to people by the bite of an infected human body louse or when the person scratches infectious feces into the skin. Inhaling dust contaminated with dried infected lice or their feces may also cause infections.

Epidemic typhus occurs in communities and refugee populations where body lice are prevalent. Outbreaks often occur during the colder months when infested clothing is not laundered. Epidemic typhus occurs most often in areas with large homeless populations, impoverished areas, refugee camps, and regions that have recently experienced natural disasters or war. People who work in or visit such areas are also at risk of contracting typhus.

Symptoms of epidemic typhus may include chills, cough, high fever (104 degrees Fahrenheit), delirium or stupor, joint pain, sensitivity to light, severe headache, severe muscle pain, low blood pressure, and a rash that begins on the chest and spreads to the rest of the body except the palms of the hands and soles of the feet. The early rash is a light rose color and fades when pressed. Later, the rash becomes dull and red and does not fade. People with severe typhus may also develop small areas of bleeding into the skin.

Prompt antibiotic treatment will cure nearly all patients. Without treatment, death may occur in 10 to 60 percent of patients with epidemic typhus. Patients over age 60 have the highest risk of death.

Measures to get rid of lice when an infection has been found include bathing and wearing clean clothing. To kill the lice, boil clothes before wearing or avoid infected clothing for at least five days (the lice will die without feeding on blood). Louse-specific insecticides may also be used.

Sylvatic epidemic typhus cases occur only from direct contact with flying squirrels or their nesting materials. The infection is endemic among flying squirrels in the eastern United States.

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