Flea-borne Typhus Public Redirect
Flea-borne (Murine) Typhus Sample Requests
What is flea-borne typhus?
Flea-borne typhus (murine typhus) is caused by Rickettsia typhi and presents with fever, headache, myalgia, and rash. These symptoms overlap with many common diagnoses and are frequently attributed to other causes. Risk factors include exposure to flea-infested animals (rats, cats, opossums) or environments, and conditions associated with outdoor or unstable housing. Because the presentation is nonspecific and routine surveillance is limited in Georgia, cases are likely under-identified.
The Atlanta Flea-Borne Typhus Work Group — a collaboration among the Georgia Department of Public Health (DPH), Fulton County Board of Health (FCBOH), and CDC's Division of Vector-Borne Diseases — was established in response to the re-emergence of this pathogen in the Southern US and elsewhere in the US since 2008. Our goal is to strengthen case detection. Provider awareness is essential to that effort.
Identifying Risk Factors
Most patients with flea-borne typhus do not report known flea contact. Because exposure is often indirect or unrecognized, a targeted exposure history is essential. When evaluating a patient with a compatible clinical presentation, ask about:
- Pets with outdoor access (cats, dogs) or known flea infestation in the home
- Contact with peridomestic wildlife — particularly rats, opossums, or stray cats — at home, work, or recreational settings
- Living or sleeping outdoors, or conditions associated with unstable housing and environmental flea exposure
These questions can help establish plausible flea exposure even when the patient has no awareness of direct flea contact.
Consider flea-borne (murine) typhus in patients presenting with acute fever, headache, myalgia, and rash with a history of flea exposure or contact with flea-associated animals.
Contact DPH (404-657-2700) for diagnostic support and to submit no-cost testing through the CDC.
Clinical Signs and Symptoms
- Fever
- Elevated liver enzymes (AST, ALT, ALP)
- Thrombocytopenia
- Hyponatremia
- Rash
- Myalgia
- Cough
- Nausea or vomiting
Collect Clinical Samples
We are asking providers who evaluate patients with a compatible clinical presentation and relevant exposure history to submit a serum sample for flea-borne typhus testing. Samples are tested at no cost to your patient or practice at the CDC.
Specimen submission supports active surveillance efforts in Georgia and contributes directly to the Atlanta Flea-Borne Typhus Work Group's investigation into local transmission patterns.
Please do not withhold treatment by doxycycline while waiting for test results.
For additional information, please see CDC's Diagnostic Testing page.
Submission to the CDC
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If patient has been treated with Doxy for more than 72 hours
- Collect at least 1 mL of serum sample
- Skip ahead to "Required Clinical Information - For ALL Submissions"
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If patient has been treated with Doxy for fewer than 72 hours
- Collect at least 1 mL of whole blood for a PCR test
- If the patient has a rash consider a skin biopsy
- Schedule a follow up appointment, including a convalescent serum collection, date 4-8 weeks later
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Required Clinical Information - For ALL Submissions
Providers will be required to submit -
- Patient name
- Patient DOB
- Relevant signs and symptoms, with onset date
- Concerning exposures
- Sample with patient name and DOB on tube and draw date documented
- POC information if there are additional questions about the sample or patient
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How to Submit a Sample
Contact the Vectorborne Disease Team at 404-657-2700 or [email protected] if you believe you have a patient with compatible symptoms who you would like to be tested. Please have all required clinical information and the sample available. Upon approval for submission, a member from this team will fill out all paperwork required and securely send you this paperwork so it may be paired with the sample and sent to the CDC.
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Sample Turnaround Time
Turnaround time for confirmatory test results may be up to 6 weeks
NOTE: The decision to treat patients for suspected flea-borne typhus should be based on clinical suspicion. Do not delay treatment with doxycycline pending laboratory confirmation.
FAQs
Flea-borne Typhus FAQs
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Why are we concerned about flea-borne typhus?
Flea-borne typhus, caused by Rickettsia typhi, is a flea-transmitted zoonosis associated with rats and other peridomestic animals. Reemergence in the U.S., primarily in CA and TX, has been ongoing since 2008. Given the natural history of the disease in the southeast and the presence of competent vectors and reservoirs, metro Atlanta represents a setting for potential local transmission. The true burden of disease is currently unknown due to limited surveillance and low clinical recognition.
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What is being done about flea-borne typhus in Georgia?
We are asking for your partnership in considering flea-borne typhus in the differential diagnosis for patients meeting clinical and epidemiologic criteria.
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What is the Atlanta Flea-borne Typhus Work Group?
The Atlanta Flea-Borne Typhus Work Group - comprised of representatives from the Georgia Department of Public Health (DPH), Fulton County Board of Health (FCBOH), and Centers for Disease Control and Prevention (CDC) Division of Vector-Borne Diseases - was recently established to enhance human disease detection and conduct an integrated vector-reservoir investigation.
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Where can I get more information on flea-borne typhus?
COCA Call: Murine Typhus: A Re-emerging Threat in the United States
During this COCA Call, presenters will review the epidemiology, diagnosis, and treatment of murine typhus, and discuss its re-emergence in the United States.CE is available through April 29, 2027.
Additional Resources
Learn more about FBT and earn free CE
Flea-borne Typhus Resources
Page updated: 10/07/26