Murine typhus in Cyprus: 21 paediatric cases

Abstract

The aim of this article is to present the manifestations of Rickettsia typhi infection in childhood. Twenty-one children under 15 years of age were hospitalised in the Department of Paediatrics of the Archbishop Makarios Hospital in Nicosia, Cyprus, from 2000 to 2006 with Rickettsia typhi infection. Ten of them were boys and 11 were girls. The median age was eight years (range four to 13 years). The most common clinical features were fever (100%) and rash (57%). Lymphadenopathy, usually cervical, was also a frequent finding (37%). Severe headache was rather infrequent (29%). Splenomegaly or hepatomegaly were less frequent findings (24% and 10%, respectively). Mild elevation of liver enzymes (AST and ALT elevated >1-fold in 81% and 75%, respectively) was the most frequent laboratory finding. Thrombocytopenia (28%) and leucopenia (17%) were less frequent. Nearly half of the patients (10/21) came from four neighbouring villages, where most residents work in agriculture. All of the children were treated with appropriate antibiotic regimens and had complete recovery. Rickettsia typhi infection should be considered in the differential diagnosis of children who present during the summer or early autumn months with prolonged fever and rash with or without lymphadenopathy.

Murine typhus in children: clinical and laboratory features from 41 cases in Crete, Greece

“…Murine typhus, also known as endemic typhus, is a flea‐borne infectious disease with a worldwide distribution, caused by an obligate intracellular, gram‐negative microorganism, Rickettsia typhi [1]. The transmitting agent of R. typhi is the rat flea, Xenopsylla cheopis , although the cat flea, Ctenocephalides felis , has also been implicated [1–4]. Main reservoirs are rats, house mice, opossums, skunks and cats [1–3].…”

Does complement Factor H-Related protein 5 Nephropathy (Troodos Nephropathy) protect from rickettsial infections?

“…The exact incidence of R.typhi infections in Cyprus was largely unknown, however, outbreaks of the infection in 1996 and 1997 [49], indicate that R.typhi infections remain a significant health problem in the island. More recently, a case series of 21 children with R. typhi infection was reported [54]. An epidemiological 9-year study of murine typhus in Cyprus has identified persistent endemic foci in the island [55].…”

CD4+ T Cells Are as Protective as CD8+ T Cells against Rickettsia typhi Infection by Activating Macrophage Bactericidal Activity

“…Rising case numbers are reported from the US (Hawaii [27] and Texas [28, 29]) as well as from Southern Europe (e.g. Cyprus [30, 31], Greece [32], Spain [33–36] including Canary Islands [37, 38]) and Portugal [39, 40]. Especially homeless people are at enhanced risk to acquire the infection.…”