Acadiana Has More Flea Typhus Cases Than the Rest of Louisiana Combined

LAFAYETTE, La. — Health officials in Louisiana are alerting residents and physicians to a significant increase in flea-borne typhus infections, with most of the confirmed cases concentrated in the Acadiana and Lafayette area. Since the beginning of 2025, the state has recorded 17 confirmed cases. Every case required hospitalization, and two patients have died.

According to the Louisiana State Board of Medical Examiners, the true case count is likely higher. Flea-borne typhus is not currently a reportable condition under Louisiana’s State Sanitary Code, meaning physicians are not required to document and report it, and many infections may go undetected or be misdiagnosed due to limited awareness.

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Why Acadiana Is at the Center of the Outbreak

The majority of cases in the current outbreak were reported in LDH Region 4, which includes Lafayette and the surrounding Acadiana parishes. State officials have noted that the concentration may partly reflect reporting bias, with physicians in the region more attuned to the diagnosis, but they have also acknowledged that the increase represents a genuine rise in infections.

Louisiana recorded just 21 total cases between 2010 and 2024. The state has nearly matched that 14-year total in the past year and a half. Cases have historically been identified in multiple regions across Louisiana, but the current outbreak has hit Acadiana harder than anywhere else in the state.

Officials also noted that expanded use of metagenomic sequencing tests, a newer diagnostic tool, may be contributing to increased detection of cases that would previously have gone unidentified.

What Flea-Borne Typhus Is and How It Spreads

Flea-borne typhus, also known as murine or endemic typhus, is caused by the bacterium Rickettsia typhi. The disease does not spread from person to person. Infection occurs when flea feces containing the bacteria enter the body through scratched skin or flea bites, are rubbed into the eyes or other mucous membranes, or are inhaled as contaminated dust.

In urban and suburban environments, rats, opossums, cats, and dogs all serve as hosts for infected fleas. Animals carrying infected fleas typically show no symptoms, so contact with a healthy-looking pet or stray animal does not rule out exposure.

The disease was once widespread in the United States but declined sharply in the 1940s following widespread pest control efforts. In recent years, cases have increased in Hawaii, California, and Texas. Louisiana is now seeing a similar trend.

Recognizing the Symptoms

Symptoms typically appear seven to 14 days after exposure and closely resemble the flu or other common illnesses. The medical board advises watching for:

• Fever and severe headache
• Muscle aches and fatigue
• Nausea, vomiting, and loss of appetite
• Abdominal pain and cough
• Altered mental status in more advanced cases
• A rash, which may develop by the end of the first week of illness, typically starts on the trunk

Laboratory findings in confirmed cases have included anemia, low platelet counts, low white blood cell counts, low sodium levels, and elevated liver enzymes. Severe cases have been associated with pulmonary complications and neurological effects.

What Doctors Are Being Told

The Louisiana State Board of Medical Examiners is directing physicians to consider flea-borne typhus in any patient presenting with compatible symptoms, particularly those who have reported recent flea or animal exposure. Officials are recommending that doctors initiate doxycycline therapy based on clinical suspicion rather than waiting for laboratory confirmation, which can delay treatment and worsen outcomes.

Treatment typically continues for at least three days after the fever resolves and until clear clinical improvement is observed, which generally occurs within seven to 10 days of starting antibiotics.

How to Reduce Your Risk

The Louisiana Department of Health recommends the following steps to reduce the risk of infection:

• Use routine flea prevention products on all household pets
• Avoid direct contact with fleas and flea feces
• Limit exposure to rodents and wild animals around homes and in recreational areas
• Seal openings in homes and outbuildings that could allow rodents to enter
• Keep outdoor trash covered to reduce rodent attraction
• Avoid feeding or handling free-roaming stray animals

Cases can be voluntarily reported even without a legal requirement, and the medical board is encouraging providers to do so to improve statewide disease tracking. Confirmed outbreaks or clusters of infectious disease remain classified as Class A conditions and must be reported to state health authorities within 24 hours.

Anyone experiencing symptoms consistent with flea-borne typhus, particularly after contact with fleas or animals, should contact a healthcare provider promptly and disclose any relevant exposure.

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