Murine Typhus in Travelers Returning from Indonesia

Parola, Philippe; Vogelaers, Dirk; Roure, C.; Janbon, F; Raoult, Didier

doi:10.3201/eid0404.980423

Cited by 50 publications

(32 citation statements)

References 12 publications

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“…typhi infections in Brazil have been reported in the past including with agent isolation from at least one human case (Travassos et al 1949), but recent reports of such infection are scarce (Silveira & Maestrini 1985, da Silva & Papaiordaou 2001. However, Brazil is considered as risk area for murine typhus according to a previous report (Parola et al 1998). Murine typhus has been considered a neglected rickettsiosis worldwide (Walker 2004a) and available data from Europe (Daniel et al 2002) and Asia (Tay et al 2003) showed higher rates than in our study.…”

Section: Discussioncontrasting

confidence: 54%

Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Costa

Brigatte

Greco

2005

Mem. Inst. Oswaldo Cruz

100

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Rickettsial diseases except those belonging to spotted fever group rickettsioses are poorly studied in South America particularly in Brazil where few epidemiological reports have been published. We describe a serosurvey for Rickettsia rickettsii, R. typhi, Coxiella burnetii, Bartonella henselae, B. quintana, and Ehrlichia chaffeensis in 437 healthy people from a Brazilian rural community. The serum samples were tested by indirected micro-immunoflourescence technique and a cutoff titer of 1:64 was used. The seroprevalence rates for R. rickettsii, R. typhi, C. burnetii, B. henselae, B. quintana, and E. chaffeensis were respectively 1.6% (7 samples (WHO 1993, Rozental et al. 2002, Walker 2004a. Until recently the rickettsiales order comprised the genus Rickettsia, Coxiella, Bartonella, Orientia, Anaplasma, and Ehrlichia (Raoult & Roux 1997) and despite of the resulting withdraw of some of them from this order especially due to 16S rRNA studies, they all can be functionally considered rickettsial agents (Raoult & Roux 1997, Walker 2004b.Most of the available publications of Brazilian rickettsial infections have focused on spotted fever group rickettsioses especially R. rickettsii infections (Lemos et al. 1994, Del Guercio et al. 1997, Rozental et al. 2002, Galvão et al. 2003. This issue has been extensively reviewed recently by Galvão (2004). Despite of the fact that new rickettsial agents have been described more recently in Brazil (Oliveira et al. 2002), the whole scenario of rickettsial infections still have black holes reinforcing the nonexistence concept for such infections in this part of the world.The Piau county as well as the southern part of the state of Minas Gerais had been considered free of any rickettsial diseases until 1994 when a family cluster of Brazilian spotted fever was reported (Hallack et al. 1996). Thereafter reports of Brazilian spotted fever have been Given these above mentioned facts and the much-appropriated local ecologic conditions for rickettsial infections we choose this particular region for studying the seroprevalence rates for R. typhi, C. burnetii, B. henselae, B. quintana, and E. chaffeensis as well as R. rickettsii infections among healthy individuals from a Brazilian rural community. MATERIALS AND METHODSSerum samples from 437 healthy individuals of both sexes aged from 5 to 92 years old, living in the county of Piau, state of Minas Gerais, Brazil were tested for the presence of R. rickettsii, R. typhi, C. burnetii phase I and phase II, B. henselae, B. quintana, and E. chaffeensis IgG and IgM antibodies. This county (Fig. 1), located at latitude 21º30'34''S and longitude 43º19'25''W, has 3008 inhabitants, 58% of them living in the small village and the remainders scattered throughout the county, mostly in small farms. The local economics is somehow linked to cattle farming and the entire population has continuous contact with several domestic animals. Tick attack history is widespread affecting roughly 100% of the population. From March to April 2001, health officials offe...

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Section: Discussioncontrasting

confidence: 54%

Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Costa

Brigatte

Greco

2005

Mem. Inst. Oswaldo Cruz

100

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“…12 Murine typhus has been mainly described in travelers returning from Indonesia. 4,11,12 In this country, recent investigations of 137 patients with fever have led to the diagnosis of murine typhus in 6.5% of cases. 16 Tunisia is also known to pose a risk for autochthonous murine typhus, although the disease is underdiagnosed or frequently misdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…The rat flea, Xenopsylla cheopis has been considered as the main vector 2 ; the major sources of human infection are flea bites and the contamination of the respiratory tract or excoriated skin with infected flea feces. 3 Murine typhus has a worldwide distribution, with the majority of cases occurring in the coastal tropical and subtropical regions 4 ; although murine typhus has been recently shown to be a significant cause of fever of unknown origin in the tropics, 5 cases are rarely documented. The disease has, however, been documented as an emerging or reemerging diseases in several areas such as Hawaii, which had six cases per year before 2002 and 47 cases reported during 2002.…”

Section: Introductionmentioning

confidence: 99%

“…10 Murine typhus has been reported in~60 travelers since 1983, when the first case of murine typhus in travelers was described. 4,9,11 Recently, the Geosentinel Network investigated the epidemiology of rickettsial diseases among 99,355 ill returned travelers between 1996 and 2008. A total of 280 rickettsial diseases were analyzed 12 ; the majority of the reported rickettsial diseases were spotted fever rickettsioses, however 10 cases of murine typhus were also documented.…”

Section: Introductionmentioning

confidence: 99%

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Murine Typhus in Returned Travelers: A Report of Thirty-Two Cases

Walter¹,

Botelho-Nevers²,

Socolovschi³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. Murine typhus, caused by Rickettsia typhi and transmitted mainly by the rat fleas, Xenopsylla cheopis, has emerged in the field of travel medicine. We analyzed retrospectively the epidemiological, clinical, and biological characteristics of the 32 murine typhus cases that were diagnosed during the past 3 years at the World Health Organization Collaborative Center for Rickettsial diseases, Marseille, France. All of the cases occurred in travelers and most of them had returned from Africa (N = 13 of 32) and South-east Asia (N = 12 of 32). Exposure to rats was reported only in a few (N = 2 of 32) patients. Almost half of the cases were diagnosed in August and September. Only four patients presented the classic triad: fever, rash, and headache. Moreover, we report the first known cases of a hemophagocytic syndrome associated with this disease. Murine typhus must be considered as an etiologic agent of febrile illness in returning travelers, particularly in those with unspecific symptoms.

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“…12,28,41,54,55 Reported mortality ranges from 1% to 4%, and higher mortality is associated with lack of antibiotics. 12 Imported murine typhus has been reported in travelers returning from Bali and Lombok regions in Indonesia [55][56][57] and also from southern Vietnam (Cu Chi) where murine typhus has not been reported since the 1960s, but probably occurs sporadically among the local population. 58 A severe case of imported murine typhus from northern Thailand causing septic shock and acute respiratory failure has also been described.…”

Section: Clinical Featuresmentioning

confidence: 99%

Rickettsial Infections in Southeast Asia: Implications for Local Populace and Febrile Returned Travelers

Aung¹,

Spelman²,

Murray³

et al. 2014

The American Society of Tropical Medicine and Hygiene

102

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Abstract. Rickettsial infections represent a major cause of non-malarial febrile illnesses among the residents of Southeast Asia and returned travelers from that region. There are several challenges in recognition, diagnosis, and management of rickettsioses endemic to Southeast Asia. This review focuses on the prevalent rickettsial infections, namely, murine typhus (Rickettsia typhi), scrub typhus (Orientia tsutsugamushi), and members of spotted fever group rickettsiae. Information on epidemiology and regional variance in the prevalence of rickettsial infections is analyzed. Clinical characteristics of main groups of rickettsioses, unusual presentations, and common pitfalls in diagnosis are further discussed. In particular, relevant epidemiologic and clinical aspects on emerging spotted fever group rickettsiae in the region, such as Rickettsia honei, R. felis, R. japonica, and R. helvetica, are presented. Furthermore, challenges in laboratory diagnosis and management aspects of rickettsial infections unique to Southeast Asia are discussed, and data on emerging resistance to antimicrobial drugs and treatment/prevention options are also reviewed.

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Murine Typhus in Travelers Returning from Indonesia

Cited by 50 publications

References 12 publications

Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Murine Typhus in Returned Travelers: A Report of Thirty-Two Cases

Rickettsial Infections in Southeast Asia: Implications for Local Populace and Febrile Returned Travelers

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