In epidemic typhus as well as endemic typhus, the rash begins on the trunk and spreads centrifugally to the extremities, but it usually spares the palms, the soles, and the face. In some patients, however, a rash appears late or does not develop. In the proper epidemiological setting, treatment must therefore be considered even in the absence of this diagnostic clue. Doxycycline or tetracycline is the antibiotic of choice. If the patient is critically ill or cannot take oral medication, antibiotics should be given intravenously.
Medication is shifted to the oral route as soon as possible.
Usually, symptoms lessen in severity within 24 hours and the fever subsides within three days. Antibiotic therapy can be discontinued after the patient has been afebrile for two or three days. In addition to the use of specific chemotherapy, treatment is aimed at correcting severe complications such as hypovolemia, congestive heart failure, electrolyte disturbances, azotemia, thrombocytopenia, and disseminated intravascular coagulation. Intravenous glucocorticoids have been used as adjuvant therapy in severely ill patients, but there are no controlled studies to support this practice. The safest and most efficacious method of removing ticks is to grasp the tick's mouthparts with tweezers as close to the patient's skin as possible and to pull upward with a steady, even pressure.