Murine typhus. How does it affect us in the 21st century? The epidemiology of inpatients in Spain (1997–2015)

Abstract

The aim of this study was to analyze the epidemiological impact of murine typhus in patients who required hospitalization in the National Health System (SNS) in Spain between 1997 and 2015. Background: Murine typhus (MT) is a zoonosis caused by Rickettsia typhi. MT is transmitted from rats, cats, dogs, and opossums to humans by their fleas. The clinical picture is characterized by headache, fever, rash, and liver function alteration. The prevalence of MT is considered underestimated since most cases are mild and self-limited. However, up to 10% of patients develop serious complications such as pneumonia or acute kidney injury and may even need admission to intensive care units. Methods: This was a retrospective longitudinal descriptive study of inpatients diagnosed with Rickettsia typhi infection (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], 081.0) in Spanish public hospitals between January 1, 1997, and December 31, 2015. Data were obtained from the Minimum Basic Data Set (MBDS, CMBD in Spanish), which includes information about inpatients admitted to the National Health System (NHS) hospitals provided by the Health Information Institute of the Ministry of Health and Equality. Results: Ninety-nine inpatients were included. The incidence rate of MT was 0.12 (95% CI, 0.09-0.14) cases per one million person-years. Cases were irregularly distributed throughout the period of study, with a slight upward trend between 2013 and 2015. The Canary Islands had the highest incidence rate: 2.17 (95% CI, 1.69-2.64) cases per one million person-years (80 cases). Most patients were men (63.6%). The mean age (AESD) was 46.4 years (AE19). Five patients were under 15 years old. Approximately 85.9% of cases required urgent hospital admissions. The average hospital stay was 11 days (AE9.9). Only 1 patient died. Conclusions: Although considered uncommon, the incidence of MT seems to be increasing slowly. Most cases occurred in middle-aged men between late summer and early autumn in Spain. The Canary Islands and Andalusia registered the highest number of cases. The MBDS is an appropriate approach to study MT hospital management.

Epidemiology of aspergillosis in hospitalised Spanish patients—A 21‐year retrospective study

“…In our work, the methodology applied is similar to use in previous studies in acute 18 and chronic infectious diseases 19 . Data were obtained from the Minimum Basic Data Set (CMBD in Spanish) recorded in each inpatient in a public hospital of the national health system.…”

Non-negligible seroprevalence of murine typhus and its predictors in Japan: a large-scale seroepidemiological study

“…MT is ubiquitous in developing countries, with seroprevalence rates of 6.5% and 5.4% in northern Vietnam (36) and southern India (18), respectively. In addition, the incidence of MT has temporarily decreased, but has become a problem in developed countries such as the US (California and Texas) (6–8), Greece (9), and Spain (10,11). One possible reason for the increase in MT in California and Texas is the improved disease recognition by clinicians through local epidemiological studies (8,37).…”

“…MT is distributed globally and is endemic in warm urban or coastal regions, where rats or cats, the reservoirs of R. typhi , tend to inhabit; however, epidemiological characteristics often differ from region to region (1). Reports from industrialized countries, such as the US (6–8), Greece (9), and Spain, (10,11) have accumulated. Epidemiological studies from the US have indicated that MT is endemic not in urban areas but in suburban areas (6,8), potentially due to a new transmission cycle between fleas and reservoirs, such as opossums (12,13).…”

Epidemiological assessment of 5598 brucellosis inpatients in Spain (1997–2015)

“…The fact that brucellosis has been identified as the primary diagnosis in more than 67% of cases indicates a much higher diagnostic suspicion than in other infections that cause fever of intermediate duration [ 21 , 22 ]. The mean stay of individuals with a secondary diagnosis is significantly longer than that in the primary forms.…”