A Typhus and Typhoid Fever Outbreak: A Diagnostic Dilemma in Joypurhat District, North-western Bangladesh, 2021

Authors

  • Sohel Rahman Institute of Epidemiology Disease Control and Research, Bangladesh
  • Alden Henderson Department of Public Health Sciences, University of Hawaiʻ i, the United States of America
  • Md. Yousuf Ali 250 Bed District Hospital, Joypurhat, Bangladesh
  • Mallick Masum Billah Institute of Epidemiology Disease Control and Research, Bangladesh
  • Ishrat Jahan Institute of Epidemiology Disease Control and Research, Bangladesh
  • Nawsher Alam Institute of Epidemiology Disease Control and Research, Bangladesh
  • Zakir Hossain Habib Institute of Epidemiology Disease Control and Research, Bangladesh
  • Murshida Khanum Institute of Epidemiology Disease Control and Research, Bangladesh
  • Tahmina Shirin Institute of Epidemiology Disease Control and Research, Bangladesh

DOI:

https://doi.org/10.59096/osir.v18i4.274571

Keywords:

typhoid fever, typhus, Rickettsia, typhus subgroups , Bangladesh

Abstract

Typhoid (enteric) and typhus (Rickettsia) fevers are endemic in Bangladesh. This study describes an outbreak initially thought to be typhoid fever, but upon several patients’ non-response to treatment, further evaluation discovered that these patients had typhus. One typhoid case did not respond to ceftriaxone (although sensitive in blood culture) and, due to empirical knowledge of the physician, was diagnosed as typhus by a significant Weil–Felix test and responded to doxycycline. A total of 241 cases were identified: 158 (65.6%) cases of typhoid fever, 44 (18.2%) with typhus, and 39 (16.2%) with typhoid and typhus co-infections. In this outbreak, cases in the spotted fever group rickettsia (SFGR) constituted the largest proportion, followed by the typhus group (TG), while the scrub typhus group (STG) had the smallest proportion. This finding was different from the typical subgroup pattern seen in Bangladesh of TG>STG>SFGR. Typhus may be misdiagnosed as typhoid fever due to similar clinical presentation, so it is essential for physicians to distinguish between the diseases because of different treatment and intervention modalities. Epidemiologists should be aware that both diseases can occur simultaneously in outbreaks. This study recommends enhanced training of physicians on the differential diagnosis of typhus and typhoid fever to reduce the misdiagnosis. In addition, laboratories need to upgrade their diagnostic protocols and capacity to use blood cultures to diagnose typhoid fever.

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Published

2025-12-31

How to Cite

Rahman, S., Henderson, A., Ali, M. Y., Billah, M. M., Jahan, I., Alam, N., Habib, Z. H., Khanum, M., & Shirin, T. (2025). A Typhus and Typhoid Fever Outbreak: A Diagnostic Dilemma in Joypurhat District, North-western Bangladesh, 2021. Outbreak, Surveillance, Investigation & Response (OSIR) Journal, 18(4), 192–199. https://doi.org/10.59096/osir.v18i4.274571

Issue

Vol. 18 No. 4 (2025): October - December

Section

Original article

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