Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1^,2

Abstract

Murine typhus occurs relatively commonly in southern Texas, as well as in California. We reviewed records of 90 adults and children in whom murine typhus was diagnosed during a 3-year period in 2 hospitals in southern Texas, USA. Most patients lacked notable comorbidities; all were immunocompetent. Initial signs and symptoms included fever (99%), malaise (82%), headache (77%), fatigue (70%), myalgias (68%), and rash (39%). Complications, often severe, in 28% of patients included bronchiolitis, pneumonia, meningitis, septic shock, cholecystitis, pancreatitis, myositis, and rhabdomyolysis; the last 3 are previously unreported in murine typhus. Low serum albumin and elevated procalcitonin, consistent with bacterial sepsis, were observed in >70% of cases. Rash was more common in children; thrombocytopenia, hyponatremia, elevated hepatic transaminases, and complications were more frequent in adults. Murine typhus should be considered as a diagnostic possibility in cases of acute febrile illness in southern and even in more northern US states.

An Unusual Case of Campylobacter jejuni Gastroenteritis Presenting with Acute Reversible Encephalopathy in an Immunocompetent Host

“…were negative [18]. In this clinical case, the neurological and gastrointestinal symptoms rapidly resolved once the patient was started on azithromycin for Campylobacter gastroenteritis.…”

“…Based on Rio Grande Valley demographics with high prevalence of murine typhus in the area, the patient was treated empirically with doxycycline until her agglutinins were negative [ 18 ]. In this clinical case, the neurological and gastrointestinal symptoms rapidly resolved once the patient was started on azithromycin for Campylobacter gastroenteritis.…”

Suspected and Confirmed Vector-Borne Rickettsioses of North America Associated with Human Diseases

“…Reasons for the geographic concentration of cases in these areas remain unclear as the vector and reservoir hosts are relatively ubiquitous. Murine typhus is not a nationally notifiable disease in the United States and one likely factor may be underdiagnoses/misdiagnoses in non-endemic regions [ 101 ]. A study conducted in Mexico City, Mexico, demonstrated a 15% (207 of 1382 individuals tested) seroprevalence of R. typhi in healthy adult blood donors, suggesting contact with R. typhi vectors and reservoir hosts may be relatively common in portions of North America [ 102 ].…”

Climate factors driven typhus group rickettsiosis incidence dynamics in Xishuangbanna Dai autonomous prefecture of Yunnan province in China, 2005–2017

“…However, sometimes murine typhus may cause severe complications if the diagnosis and treatment are not timely [7]. In recent years, many regions have reported murine typhus cases with severe complications, such as pneumonia, pancreatitis, and septic shock [8][9][10]. There are only a few regions still monitor murine typhus, such as Texas, Hawaii, California and Taiwan [7,11].…”