Fatal Flea-Borne Typhus in Texas: A Retrospective Case Series, 1985–2015

Abstract

Flea-borne (murine) typhus is a global rickettsiosis caused by Rickettsia typhi. Although flea-borne typhus is no longer nationally notifiable, cases are reported for surveillance purposes in a few U.S. states. The infection is typically self-limiting, but may be severe or life-threatening in some patients. We performed a retrospective review of confirmed or probable cases of fatal flea-borne typhus reported to the Texas Department of State Health Services during 1985–2015. When available, medical charts were also examined. Eleven cases of fatal flea-borne typhus were identified. The median patient age was 62 years (range, 36–84 years) and 8 (73%) were male. Patients presented most commonly with fever (100%), nausea and vomiting (55%), and rash (55%). Respiratory (55%) and neurologic (45%) manifestations were also identified frequently. Laboratory abnormalities included thrombocytopenia (82%) and elevated hepatic transaminases (63%). Flea or animal contact before illness onset was frequently reported (55%). The median time from hospitalization to administration of a tetracycline-class drug was 4 days (range, 0–5 days). The median time from symptom onset to death was 14 days (range, 1–34 days). Flea-borne typhus can be a life-threatening disease if not treated in a timely manner with appropriate tetracycline-class antibiotics. Flea-borne typhus should be considered in febrile patients with animal or flea exposure and respiratory or neurologic symptoms of unknown etiology.

High Morbidity Due to Murine Typhus Upsurge in Urban Neighborhoods in Central Israel

“…Worse outcome for elderly patients may also be inferred from a recent series of fatal murine typhus cases. 8 In this report, most of the patients were older than 50 years, and their median age was 62 years. They presented with a high rate of pulmonary (55%) and neurologic (63%) complications.…”

“…6 A spectrum of severe manifestations has been described, particularly in hospitalized patients, but mortality is rare. 7,8 Laboratory diagnosis is based on sensitive serologic tests, such as indirect fluorescent antibody (IFA) assays. Diagnostic titer is present in about half of the patients within the first week of infection, and in most patients within the second week.…”

Trends in clinical diagnoses of typhus group rickettsioses among a large U.S. insurance claims database

“…Overall, the seasonality and geographic distribution of MarketScan® patients diagnosed with murine typhus matched the expected patterns. Today, nearly all cases of murine typhus occur in southern Texas, southern California and Hawaii and cases peak in the warmer months of late spring through early fall (Blanton, Vohra, Bouyer, & Walker, ; Civen & Ngo, ; Hoskinson et al, ; Pieracci et al, ). In the MarketScan® population, more than 75% of patients resided in the south and west regions and diagnoses peaked during the months of May–August.…”

“…Texas, which reports the highest number of murine typhus cases, has experienced a geographic expansion of murine typhus in the last decade. Once primarily restricted to South Texas, healthcare providers now diagnose patients in Austin, Dallas–Fort Worth and Houston areas (Adjemian et al, ; Elliott, Fournier, & Teltow, ; Campbell et al, ; Pieracci et al, ; Texas Department of State Health Services, ).…”

Rickettsial Infections among Cats and Cat Fleas in Riverside County, California

“…[22][23][24][25] Although human R. felis infections have been seen in Central and South America, [23][24][25] R. felis is generally not considered a cause of flea-borne rickettsioses in the United States. [22][23][24][25][26][27][28] However, reports from California indicate that R. typhi-endemic areas overlap (because of the common flea vectors) with areas where R. felis infections could be endemic. 11,15,19,20,29,30 To further complicate matters, the clinical symptomology, consisting of high fever, headache, myalgia, and rash, of R. typhi and R. felis infections in humans is similar.…”