Analysis of Health-Care Charges in Murine Typhus: Need for Improved Clinical Recognition and Diagnostics for Acute Disease

Abstract

Murine typhus, caused by , is an undifferentiated febrile illness with no available rapid and sensitive diagnostic assay for use during early disease. We aimed to compare the health-care charges in those diagnosed with murine typhus to those with influenza, a febrile illness with an available rapid diagnostic test. A comparison of health-care-associated charges at the University of Texas Medical Branch at Galveston demonstrated a median of $817 for influenza versus $16,760 for murine typhus ( < 0.0001). Median laboratory ($184 versus $3,254 [ < 0.0001]) and imaging charges ($0 versus $514 [ < 0.0001]) were also higher in those with murine typhus. Those receiving at least one imaging study during their illness were greater in the murine typhus group (91.3% versus 20.3%) ( < 0.0001). The median time needed to establish a confirmed or presumptive diagnosis was 2 days for influenza compared with 9 days for murine typhus ( < 0.0001). The median number of health-care encounters was greater for those with murine typhus (2 versus 1) ( < 0.0001). Eleven patients (15.9%) with influenza were hospitalized as a result of their illness compared with 16 (69.6%) with murine typhus ( < 0.0001). The estimated mortality based on disease severity at presentation by Acute Physiology and Chronic Health Evaluation II scoring was similar in the two groups-both had a median 4% mortality risk ( = 0.0893). These results highlight the need for improved clinical recognition and diagnostics for acute rickettsioses such as murine typhus.

Murine typhus mistaken for COVID-19 in a young man

“…Because the symptoms of murine typhus can be nonspecific, it can be challenging to diagnose in a timely manner. 4 8 This is especially true during the current COVID-19 pandemic where the non-specific presenting symptoms of murine typhus—fever, headache and myalgia—overlap with symptoms of COVID-19. The symptom overlap of fever, reported in over 90% of patients with murine typhus and in 83%–98% of patients with COVID-19, may blind the clinician from exploring the broader differential diagnoses of other febrile illness.…”

“… 15 Early recognition of this disease and prompt intervention with doxycycline will result in more favourable outcomes. 4 During this pandemic, medical providers should develop more comprehensive differential diagnoses in patients who experience persistent symptoms that overlap with COVID-19 and repeatedly test negative for it.…”

“… 2 While many studies describe cats as domestic reservoir hosts, it can also exist in dogs. 3 In the USA, murine typhus is endemic to Hawaii, South Texas and Southern California, 4 and has been more often reported during warmer seasons. 2 Because the disease has a non-specific clinical presentation, and often self-limited nature, it may be difficult to diagnose.…”

“… 2 Because the disease has a non-specific clinical presentation, and often self-limited nature, it may be difficult to diagnose. 4 As a result—it can be misdiagnosed and under-reported. 3 While many cases are mild, there have been reports of death related to murine typhus.…”

A systematic review of the untreated mortality of murine typhus

“…Our review showed a mean duration of fever of up to 15 days and a high rate of hospitalisation and complications in untreated patients. Since treatment with doxycycline has been shown to lead to a cessation of fever with a mean of 3 days [4,5] and a recent study [6] found significantly higher healthcare charges for murine typhus patients when compared with influenza, the importance of early diagnosis and treatment of this neglected disease cannot be overstated. That it is readily treatable with tetracyclines [5] should encourage more clinical awareness as an inexpensively and simply treatable infectious disease that can lead to complications.…”