Imported rickettsial infections to the United Kingdom, 2015–2020

Warrell, Clare E.; Osborne, Jane; MRCP, Laura Nabarro; Gibney, Barry C.; Carter, Dan; Warner, John T.; Houlihan, Catherine; Brooks, Timothy; Rampling, Tommy

doi:10.1016/j.jinf.2023.03.015

Cited by 5 publications

(1 citation statement)

References 34 publications

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“…The increased recognition of cases in Southern California, Texas, Mexico, and South America highlights the reemergence of the pathogen in these regions. It has also been described in travelers where it has been reported to have been acquired via travel to Asia, Africa, and the Americas [98][99][100][101][102].…”

Section: Epidemiology Of An Underrecognized and Reemerging Cause Of I...mentioning

confidence: 96%

Murine Typhus: A Review of a Reemerging Flea-Borne Rickettsiosis with Potential for Neurologic Manifestations and Sequalae

Blanton

2023

Infectious Disease Reports

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Murine typhus is an acute febrile illness caused by Rickettsia typhi, an obligately intracellular Gram-negative coccobacillus. Rats (Rattus species) and their fleas (Xenopsylla cheopis) serve as the reservoir and vector of R. typhi, respectively. Humans become infected when R. typhi-infected flea feces are rubbed into flea bite wounds or onto mucous membranes. The disease is endemic throughout much of the world, especially in tropical and subtropical seaboard regions where rats are common. Murine typhus is reemerging as an important cause of febrile illness in Texas and Southern California, where an alternate transmission cycle likely involves opossums (Didelphis virginiana) and cat fleas (Ctenocephalides felis). Although primarily an undifferentiated febrile illness, a range of neurologic manifestations may occur, especially when treatment is delayed. Serology is the mainstay of diagnostic testing, but confirmation usually requires demonstrating seroconversion or a fourfold increase in antibody titer from acute- and convalescent-phase sera (antibodies are seldom detectable in the first week of illness). Thus, early empiric treatment with doxycycline, the drug of choice, is imperative. The purpose of this review is to highlight murine typhus as an important emerging and reemerging infectious disease, review its neurologic manifestations, and discuss areas in need of further study.

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