Murine Typhus in Latin America: Perspectives of a Once Recognized but Now Neglected Vector-Borne Disease

Abstract

Murine typhus is an undifferentiated febrile illness. Historically recognized throughout Latin America, it has been seldom reported in recent decades. When clinicians and researchers are attuned, endemic foci have reemerged. The demonstrable seroprevalence in areas devoid of reported cases indicates murine typhus is an underappreciated infectious disease in Latin America.

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

“…Many MT patients recover completely with or without antibiotics, while some may result in serious outcomes, such as hospitalization or death (4,5). However, diagnosing MT solely based on symptoms is very difficult, because MT presents with nonspecific symptoms such as fever, headache, and rash, which are also seen in other rickettsial infections and in some viral infections such as COVID-19 (3,5,42). As MT can present with intermediate fevers of 7–28 days in untreated cases (5,43), it may be reasonable to proactively test for MT in cases with these presentations and the epidemiologic characteristics.…”

“…MT symptoms include fever, headache, and rashes and may mimic those of viral or other rickettsial infections. Laboratory diagnostics, such as indirect immunoperoxidase (IP) or indirect immunofluorescence (IF) assays, are commercially unavailable (1)(2)(3). Therefore, the difficulty in diagnostic confirmation makes MT neglected.…”

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

“…It is unclear if there was a true decline, perhaps related to the broad use of DDT in malaria control programs, underreporting, or lack of clinical recognition. When sought by clinicians and researchers, the presence of murine typhus as a reemerging disease entity in South America becomes evident [91]. In North America, cases are recognized in Mexico [92,93] and in the U.S. states of Hawaii, California, and Texas [94][95][96].…”

“…The aforementioned campaign using DDT to control rat flea populations, as well as the subsequent fall of cases in the United States, exemplifies the effectiveness of vector control measures to curb disease transmission [51,54]. The extensive use of DDT in Latin America to control malaria is temporally associated with a marked decrease in reporting or recognition of murine typhus in this region [91,167]. It is unknown if similar methods to control fleas on other mammalian hosts (i.e., opossums) would effectively control murine typhus.…”

Rickettsia typhi in Southern California: A Growing Flea-Borne Threat

“…Thus, flea-borne typhus is easily mistaken for diseases caused by various other pathogens. 8 The lack of an accurate, rapid diagnostic test employable during the early phase of illness and reliance on serology for diagnosis (antibodies are seldom detected in the first several days of illness), 9 further clouds our ability to recognize flea-borne typhus and establish its contribution to illness within a community. Despite the difficulties in establishing a diagnosis, it has become clear that flea-borne typhus is becoming increasingly prevalent.…”