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Murine typhus is a disease still prevalent in many parts of the world. Because the incidence in the US and Europe has declined rapidly, physicians in these continents have become unfamiliar with the clinical picture. Murine typhus is associated with significant morbidity and fatalities do occur, especially in the elderly and when late recognized. We present a patient with murine typhus that illustrates the wide variety of symptoms in this disease, which makes diagnosis difficult. However, if one keeps the possibility of murine typhus in mind, it is easily diagnosed and treated.
Murine (endemic) typhus is a notifiable disease in Hong Kong, but its diagnosis can be difficult. We report a case of murine typhus in a middle-aged man who presented with persistent fever, headache, and skin rash 2 weeks after returning from a visit to China. The diagnosis of murine typhus requires a high index of suspicion for a febrile patient with a history of potential exposure to the disease vector (rat flea) in an endemic area. The importance of early recognition lies in the potential for early therapeutic intervention, leading to decreases in morbidity and duration of stay in hospital.
Dog sera, collected from different communities throughout Selangor, Peninsular Malaysia, were investigated for the presence of antibodies to R. tsutsugamushi and R. typhi. Scrub typhus antibodies were present in animals from the rural areas only, whereas murine typhus antibodies were observed in equal numbers of dogs from both rural and metropolitan areas. Greater percentage of dogs from suburban areas had demonstrable antibody titers to murine typhus than from the urban area.
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A multi-test strip dotblot immunoassay for the diagnosis of typhoid fever, scrub typhus, murine typhus, dengue virus infection and leptospirosis was evaluated in Thai adults presenting to hospital with acute, undifferentiated fever. The kit gave multiple positive test results in 33 of 36 patients with defined infections and was therefore not a useful admission diagnostic tool.
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Murine typhus, a zoonotic disease caused by Rickettsia typhi, is uncommon in the United States. Hawaii typically reports five or six cases annually; however, 47 cases were reported in 2002. This report summarizes clinical data for three of these cases and describes murine typhus activity in Hawaii during 2002 and control efforts of the Hawaii Department of Health (HDH). The high number of reported cases in 2002 underscores the need for community education to prevent murine typhus and an assessment of environmental factors that might contribute to local disease transmission.
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Murine typhus is a febrile systemic illness, presenting with headache and undulating fever. Neurological involvement is considered a rare complication. During 1994 and 1995, 34 patients admitted to our hospital were diagnosed as having murine typhus. Five of these patients presented with a syndrome of subacute "aseptic" meningitis or meningoencephalitis. Three had bilateral papilloedema and 2 had focal neurological signs. None had a rash or other systemic findings suggestive of rickettsial disease. The diagnosis was based on serum and cerebrospinal fluid serology and on prompt response to doxycycline therapy. These cases suggest that neurological involvement in murine typhus is more common than previously suspected and that murine typhus should be included in the differential diagnosis of subacute meningitis in endemic areas.
BACKGROUND: Murine typhus is a zoonotic infection caused by Rickettsia typhi. This illness used to be endemic in the southeastern and gulf coast of the United States and is now only rarely reported in South Texas and Southern California. Murine typhus causes a febrile illness with headache and rash that has been well-described in adults. OBJECTIVE: To define the epidemiologic and clinical characteristics, laboratory findings, hospital course and response to therapy of children discharged from our hospital with a diagnosis of murine typhus. METHODS: Retrospective chart review of all children discharged from Driscoll Children's Hospital, Corpus Christi, TX, from January 1, 1990, to June 30, 1998, with a diagnosis of murine typhus. Patients. Thirty children (17 females) ages 2 to 17 years (mean, 10 +/- 4 years). RESULTS: Eighty percent of the children were admitted between May and November, and 67% had a history of contact with or exposure to a potential animal reservoir. Children were admitted after a mean of 7 +/- 4 days. The most common clinical features were fever 100%, rash 80% and headache 77%. Laboratory abnormalities included elevated erythrocyte sedimentation rate (75%), elevated serum transaminases (67%), hyponatremia (66%) and increased immature leukocytes without leukocytosis (63%). Only one child had leukocytosis and 40% had leukopenia. Defervescence occurred a mean of 35 +/- 19 h after initiation of appropriate antibiotics. Hospitalization lasted for a mean of 7 +/- 3 days. There were no readmissions and no patients died as a result of the infection. CONCLUSIONS: Despite being rarely reported in this country now, murine typhus continues to be an important cause of fever and hospitalization for children in South Texas. Children with murine typhus develop an illness similar to that reported in adults with fever, rash and headache. Children respond quickly to therapy with doxycycline or tetracycline and recover completely from their illness.
Murine typhus is a rickettsial infection that remains endemic in parts of Texas and California. Clinical manifestations of the infection are due to vasculitis. In a patient who acquired the infection in the United States, computed tomography demonstrated intrasplenic pseudoaneurysms, infarcts, and hemorrhage.
Murine typhus or endemic typhus is a wide spread infectious disease, with a low prevalence in developed countries, but surely underdiagnosed. Its relative benignity, the similarity to other infectious diseases and the discretion of its epidemiologic chain, as well as the usual unexpectedness of its existence, makes its diagnosis more difficult. The clinical presentation and evolution of this case illustrate the necessity of being aware of this nosological entity.
Murine typhus occurred in 254 individuals in Kuwait between April and August 1978; 81% of patients were aged between 15 and 44 years, and 63% were male. The highest attack rate occurred among people in the lowest socioeconomic class. The outbreak coincided with a period of high rat and flea density. A study of the first 104 cases suggested that infection was acquired in the home, but a case - control study revealed no significant differences between patients and control subjects in terms of exposure to rats or domestic animals, and other factors. This suggests that murine typhus is hyperendemic rather than epidemic in Kuwait. The disease is being controlled through reduction of both flea and rat populations. Murine typhus may be much more common in many areas than is generally realized, and its status should be re-evaluated regularly in all known and potential foci.
Murine typhus (etiologic agent: Rickettsia typhi) is endemic to Indonesia, especially on the highly populated island of Java. A survey of rodents from Irian Jaya, the eastern-most province of Indonesia, indicated striking geographic variation in risk factors associated with murine typhus. Murid rodents (n = 112) collected from two villages in the Arso district of northeastern Irian Jaya, were found to be free of ectoparasites normally associated with transmission of R. typhi (i.e., Xenopsylla cheopis). All rodents (n = 72) tested by enzyme-linked immunosorbent assay were negative for antibodies to R. typhi, whereas 12.5% (9/72) were positive for antibodies to Orienta tsutsugamushi. In contrast, both Rattus norvegicus and R. rattles (combined n = 87) from the harbor area of the provincial capital, Jayapura, were infested with flea ectoparasites. X. cheopis was found on 31 (35.6%) of the live-captured rodents. Serum samples from nine of 82 rodents contained antibodies reactive to R. typhi (11.0%). These data show for the first time that rodents exposed to R. typhi are well established in Jayapura, and that some of these rodents harbor fleas potentially capable of transmitting murine typhus and plague.