On average, the rash of epidemic typhus appears on day 5 of illness and consists initially of pink macules in the axillary areas, which subsequently spread over the trunk and limbs and eventually become petechial. Thus, epidemic typhus may be very difficult to distinguish from typhoid fever in the early phase of illness. Chloramphenicol has been effective against both typhoid fever and typhus. Therefore, epidemic typhus should be considered in the differential diagnosis of typhoid fever, in particular when epidemiologic conditions may have led to contact with body lice. Because infection is lifelong, humans are regarded as the main reservoir of the bacteria.
Body lice are prevalent among the homeless in industrialized regions such as Marseilles, France.
Disease surveillance, delousing of exposed persons, and improvement of the living conditions of populations at risk should prevent the reemergence of louse-borne diseases in industrialized countries. The authors thank J. Bakken for review of the manuscript for English. Dr. Niang is a fellow in the infectious disease and tropical medicine unit at the Houphouet Boigny University Hospital, Marseilles, France. His fields of interest are rickettsial diseases and bacterial infections. References 1 .