Clinical, Laboratory, and Epidemiologic Features of Murine Typhus in 97 Texas Children

Whiteford, Sarah F.; Taylor, Jeffery P.; Dumler, J. Stephen

doi:10.1001/archpedi.155.3.396

Cited by 98 publications

(81 citation statements)

References 9 publications

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“…Although our study did not extend throughout the full year, murine typhus was more common in winter than in summer. This fi nding contrasts with the summer-autumn predominance reported in other regions (13,14). We also noted a clear predominance of cases from Kathmandu and none from the Patan side of the city, despite the fact that the latter is the main catchment area for Patan Hospital.…”

Section: Discussioncontrasting

confidence: 99%

Murine Typhus and Febrile Illness, Nepal

Zimmerman¹,

Murdoch²,

Rozmajzl³

et al. 2008

Emerg. Infect. Dis.

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Murine typhus was diagnosed by PCR in 50 (7%) of 756 adults with febrile illness seeking treatment at Patan Hospital in Kathmandu, Nepal. Of patients with murine typhus, 64% were women, 86% were residents of Kathmandu, and 90% were unwell during the winter. No characteristics clearly distinguished typhus patients from those with blood culture-positive enteric fever.I n 2001, we found Salmonella enterica serotype Typhi and S. enterica serotype Paratyphi A to be the most common causes of bloodstream infections among adults with febrile illness who sought treatment at Patan Hospital in Kathmandu, Nepal (1). Another important fi nding was the relatively high percentage of patients (11%) who had immunoglobulin (Ig) M antibodies against Rickettsia typhi in peripheral blood. Because most testing was performed on unpaired acute-phase sera, and a high percentage of seropositive results were found in a group of healthy study participants, we were uncertain whether these participants had acute murine typhus or more distant past infection.Recent studies have shown the value of PCR for diagnosing scrub typhus (2-4), and a real-time assay for R. typhi has recently been validated (5). In our study, we tested archived blood samples from our febrile adult cohort (1) with this R. typhi PCR to better characterize the incidence of murine typhus and to determine whether clinical features could help distinguish murine typhus from enteric (typhoid) fever. The StudyWe studied consecutive adult patients with fever (axillary temperature >38°C; >13 years of age) who sought treatment at Patan Hospital from January 15 through March 15, 2001 (winter) and July 2 through August 10, 2001 (summer), as detailed elsewhere (1). The study was approved by the Nepal Health Research Council and the Institutional Review Board of the Centers for Disease Control and Prevention. Blood from each patient was injected into blood culture bottles and serum samples were tested for R. typhi IgM antibodies (INDX Multi-Test Dip-S-Ticks SDLST; Integrated Diagnostics, Inc., Baltimore, MD, USA). In addition, whole blood samples (stored at −80ºC) were tested by real-time PCR for R. typhi at the Naval Medical Research Center, Silver Spring, MD (NMRC) and at Canterbury Health Laboratories, Christchurch, New Zealand (CHL). Details of the assay have been described elsewhere (5). We extracted DNA from 200 μL of whole blood and used primers and probes specifi c to a portion of the outer membrane protein B (ompB) unique to R. typhi to amplify and detect the target sequence in a SmartCycler (Cepheid, Sunnyvale, CA, USA) at NMRC and in a LightCycler (Roche Diagnostics, Mannheim, Germany) thermocycler at CHL. Thermocycling parameters included an initial denaturation step (2 min at 9°C) followed by 45 cycles of denaturation (94°C for 5 s) and annealing/ elongation (60°C for 30 s) steps. Positive samples were defi ned as those that demonstrated fl uorescence above background levels. Template-free controls assayed at the same time and under the same conditions as the experimental a...

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Section: Discussioncontrasting

confidence: 99%

Murine Typhus and Febrile Illness, Nepal

Zimmerman¹,

Murdoch²,

Rozmajzl³

et al. 2008

Emerg. Infect. Dis.

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“…2 The classic triad consists of fever, headache, and rash and was found in 18% of the adult patients who presented in the series in Texas, whereas the triad was found in 49% of the patients in a pediatric series in Texas. 22,23 Our results were similar to the findings of Dumler and others 23 ; this triad cannot be considered to be a pathognomonic sign because it is inconsistent. The hemophagocytic syndrome occurred in three cases, but all the diagnostic criteria could be obtained in only one case.…”

Section: Discussionsupporting

confidence: 90%

“…Digestive symptoms seem to be particularly frequent in children, occurring in 77% of the children in a study conducted in Texas. 22 The rash often appears a week after the onset of fever and is discrete, however, the rash is not always found. 2 The presence of a rash is highly variable from one patient to another, ranging from 20% to 80% of cases, depending on the study.…”

Section: Discussionmentioning

confidence: 99%

Murine Typhus in Returned Travelers: A Report of Thirty-Two Cases

Walter¹,

Botelho-Nevers²,

Socolovschi³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. Murine typhus, caused by Rickettsia typhi and transmitted mainly by the rat fleas, Xenopsylla cheopis, has emerged in the field of travel medicine. We analyzed retrospectively the epidemiological, clinical, and biological characteristics of the 32 murine typhus cases that were diagnosed during the past 3 years at the World Health Organization Collaborative Center for Rickettsial diseases, Marseille, France. All of the cases occurred in travelers and most of them had returned from Africa (N = 13 of 32) and South-east Asia (N = 12 of 32). Exposure to rats was reported only in a few (N = 2 of 32) patients. Almost half of the cases were diagnosed in August and September. Only four patients presented the classic triad: fever, rash, and headache. Moreover, we report the first known cases of a hemophagocytic syndrome associated with this disease. Murine typhus must be considered as an etiologic agent of febrile illness in returning travelers, particularly in those with unspecific symptoms.

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“…The male-tofemale ratio for patients with R. typhi infection has been reported to be 0.67-1.50 in previous studies, 1,8,[20][21][22] but was 2.12 in our study. Such a sex discrepancy may be related to men having more opportunities to stay outdoors.…”

Section: Discussioncontrasting

confidence: 63%

“…1,[8][9][10]20,22 However, frank hepatitis with jaundice in murine typhus has rarely been reported, and only 3-11% of reported cases were associated with jaundice. 1,9,20 The definitions of acute hepatitis vary, making comparisons between reports difficult. Approximately two-thirds of our patients had biochemical hepatitis, and hyperbilirubinemia, defined as a total bilirubin level 1.4 mg/dL, was observed in 35.4% of our patients.…”

Section: Discussionmentioning

confidence: 99%

Murine Typhus in Southern Taiwan during 1992–2009

Chang

Chen

Lee³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. Clinical information regarding murine typhus in Taiwan is limited. In this study, 81 cases of serologically documented murine typhus during 1992-2009 at four referral hospitals in southern Taiwan were analyzed. There was a significant correlation between average environmental temperature and case numbers of murine typhus (r = 0.747, P = 0.005). Acute hepatitis was found in 67% of cases, and hyperbilirubinemia (serum total bilirubin 23.9 μmol/L) was found in 38%. The intervals between the initiation of appropriate therapy to defervescence were longer in patients with hyperbilirubinemia than those without hyperbilirubinemia (6.1 versus 4.1 days; P = 0.015). Nine (11.1%) showed development of severe illnesses such as acute respiratory distress syndrome (2 patients), aseptic meningitis (3), and acute renal failure (4). Only one died of acute respiratory distress syndrome. Cases of murine typhus were often found during the summer and had acute febrile hepatitis. Those patients with hyperbilirubinemia tended to have a delayed recovery even with appropriate therapy.

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Clinical, Laboratory, and Epidemiologic Features of Murine Typhus in 97 Texas Children

Cited by 98 publications

References 9 publications

Murine Typhus and Febrile Illness, Nepal

Murine Typhus and Febrile Illness, Nepal

Murine Typhus in Returned Travelers: A Report of Thirty-Two Cases

Murine Typhus in Southern Taiwan during 1992–2009

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