Endemic (Murine) Typhus in Returned Travelers from Asia, a Case Series: Clues to Early Diagnosis and Comparison with Dengue

Rickettsioses and Q fever in travelers (2004–2013)

“…In 2013, two cases of encephalitis were reported. One case involved a 53-year-old man who became ill one week after returning from a two-week holiday to Bali, Indonesia, and the other case involved a 59-year-old female who presented two weeks after returning from Bali with a 1-week illness characterized by myalgia, headache, and fever [60]. In each case, evolution was favorable with doxycycline.…”

“…In the past 10 years, approximately 50 more cases of murine typhus have been published, including travelers returning from Asia (23/51, 45%), Africa (33) [57e59], and the Middle East (4%) [60,61], with travelers originating from Europe, Japan, the Canary Islands and Australia. All patients presented with a fever and a flu-like syndrome, and 49% of these individuals had a maculopapular rash (25/51) [56,58,60e66].…”

Rickettsial Infections in Southeast Asia: Implications for Local Populace and Febrile Returned Travelers

“…46 A small comparative case series study in febrile returned travelers also found that an increased level of C-reactive protein and absence of neutropenia may help differentiate rickettsial infections from dengue. 48 Although a thorough history and clinical examination may assign a pre-test probability of rickettsial infections, no single factor reliably separates rickettsioses from other infections in either the local populace or returned travelers.…”

Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report

“…Compared to a hospitalization rate of about 10% in SFG-patients, hospitalization rate in travelers with scrub typhus or murine typhus can reach 37 or 50% respectively [6, 15]. Similarly to what is observed in the spotted fever group [18], complications as diverse as hematophagocytic syndrome, myocarditis, shock, renal failure, acute respiratory distress syndrome or encephalitis have been reported in travelers presenting with murine [1, 19–21] or scrub typhus [22–24]. Mortality rates are generally low (0–6%) in high-resource settings [6, 15], even in case of diagnostic delay, but remain substantial in most endemic areas [25, 26].…”