Epidemic typhus presents abruptly with the onset of high fevers, prostration, severe headache, cough, and severe myalgias. Photophobia with conjunctival injection and eye pain is also common.

• A rash appears on the upper trunk around the fifth day of illness and spreads to involve all body-surface areas except the face, palms, and soles.
• Confusion and coma, skin necrosis, and gangrene of the digits are noted in severe cases.
• Untreated, the disease is fatal in 7-40% of cases. Pts develop renal failure, multiorgan involvement, and prominent neurologic manifestations.