Rats, cats, and opossums maintain the rickettsia colonization by providing it with a host for its entire life cycle.

Less often, endemic typhus is caused by Rickettsia felis and transmitted by fleas carried by cats or opossums.

In the United States of America, murine typhus is found most commonly in southern California,[4] Texas and Hawaii.

[5] As of 2014[update], early diagnosis continued to be based on clinical suspicion, and treatment of the disease is indicated even before laboratory results confirm its presence.

Most people recover fully, but death may occur in the elderly, severely disabled or patients with a depressed immune system.