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Louse-borne typhus is a rickettsial infection transmitted by the human body louse. (Head lice and pubic lice do not transmit the disease.) Infection occurs when a person rubs crushed lice or louse feces into a break in the skin, often as a result of scratching. Louse-borne typhus may cause epidemics in refugee camps or any other situation that results in overcrowding and difficulty maintaining personal cleanliness, so that people become infested with lice and readily pass them to one another. Typhus also occurs sporadically in the highlands and cooler areas of Africa, Asia, and Central and South America. Initial symptoms include fever, chills, malaise, muscle aches, and severe headaches, followed by a rash between the fourth and seventh days of illness, at first on the upper trunk, then spreading to the rest of the body except the face, palms, and soles. Neurologic symptoms may include lethargy, delirium, or stupor progressing to coma. The drug of choice is doxycycline, which is safe and highly effective. Decontamination and delousing of all typhus patients and their clothing is essential to prevent spread. In general, travelers are not at risk for louse-borne typhus, except for health care providers and those living in intimate contact with affected populations.
From the World Health Organization (WHO)
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