Murine typhus in Tunisia: A neglected cause of fever as a single symptom

Znazen, Abir; Hammami, B.; Mustapha, A. Ben; Chaari, S.; Lahiani, D.; Maâloul, I.; Jemâa, Mounir Ben; Hammami, Adnène

doi:10.1016/j.medmal.2013.02.007

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…Data on presence or absence of radiographic abnormalities were mentioned in 9 study reports ( 4 – 12 ). Taken together, these studies evaluated 621 patients and 104 chest radiographs showing abnormalities, leading to a prevalence rate of chest radiograph abnormalities of 16.7% (95% CI 8.21–25.5).…”

Section: The Studymentioning

confidence: 99%

Severe Murine Typhus with Pulmonary System Involvement

Vaart¹,

Thiel²,

Juffermans³

et al. 2014

Emerg. Infect. Dis.

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Section: The Studymentioning

confidence: 99%

Severe Murine Typhus with Pulmonary System Involvement

Vaart¹,

Thiel²,

Juffermans³

et al. 2014

Emerg. Infect. Dis.

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“…7,8 Serology should therefore be performed more systematically and preferably in paired serum samples to assess dynamic rises in titers in febrile patients returning from endemic areas. 9 Our patient did not present the triad of fever, headache, and skin rash. In a recent series of 32 patients with MT, all presented with fever, but only 12% of patients presented with classical triad, 47% with exanthema, 34% with headache, 37% with digestive signs, 16% with hepato/splenomegaly, 28% with arthralgia/myalgia, 9% with confusion, 1 patient with septic shock, and 1 with myocarditis.…”

Section: Discussionmentioning

confidence: 53%

Noneruptive Fever Revealing Murine Typhus in a Traveler Returning From Tunisia

Gastellier

Renvoisé²,

Rivière

et al. 2015

J Travel Med

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Rickettsia species are increasingly being recognized as a cause of infection among returning travelers. Murine typhus (MT) was mistakenly thought to have disappeared in the 1970s in Tunisia, yet recent serological data show that Rickettsia typhi, the causative agent of MT, still circulates in the Tunisian population. We report here a case of MT in a woman returning from Tunisia and hospitalized in France. Her presentation was nonspecific, with acute noneruptive fever. Diagnosis was confirmed by cross-adsorption and immunoblotting. Clinicians taking care of returning travelers with fever should be aware of MT, and know how to diagnose and treat it.

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“…MT is one of the most prevalent Rickettsioses worldwide distributed (CDC 2009;Dzul-Rosado et al 2013;Gillespie et al 2009;Nogueras et al 2013a;Phongmany et al 2006;Znazen et al 2013); however, its real prevalence is unknown in many countries. MT is usually a mild and acute disease, whose main clinical signs are fever and rash.…”

Section: Introductionmentioning

confidence: 99%

“…MT is usually a mild and acute disease, whose main clinical signs are fever and rash. However, it can become worse in its severity and even be fatal (CDC 2009;Phongmany et al 2006;Znazen et al 2013). A misdiagnosis increases the risk of severity.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, cross reactions have been observed among rickettsiae. As a result, these infections can go unnoticed or not correctly diagnosed (Ben-Zvi et al 2010;Dzul-Rosado et al 2013;Phongmany et al 2006;Znazen et al 2013). The cell culture isolation allows the detection of pathogens during the early stages prior to seroconversion as well as the isolation of new strains.…”

Section: Introductionmentioning

confidence: 99%

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Shell-vial culture and real-time PCR applied to Rickettsia typhi and Rickettsia felis detection

Segura

Pons

Pla³

et al. 2015

World J Microbiol Biotechnol

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Murine typhus is a zoonosis transmitted by fleas, whose etiological agent is Rickettsia typhi. Rickettsia felis infection can produces similar symptoms. Both are intracellular microorganisms. Therefore, their diagnosis is difficult and their infections can be misdiagnosed. Early diagnosis prevents severity and inappropriate treatment regimens. Serology can't be applied during the early stages of infection because it requires seroconversion. Shell-vial (SV) culture assay is a powerful tool to detect Rickettsia. The aim of the study was to optimize SV using a real-time PCR as monitoring method. Moreover, the study analyzes which antibiotics are useful to isolate these microorganisms from fleas avoiding contamination by other bacteria. For the first purpose, SVs were inoculated with each microorganism. They were incubated at different temperatures and monitored by real-time PCR and classical methods (Gimenez staining and indirect immunofluorescence assay). R. typhi grew at all temperatures. R. felis grew at 28 and 32 °C. Real-time PCR was more sensitive than classical methods and it detected microorganisms much earlier. Besides, the assay sensitivity was improved by increasing the number of SV. For the second purpose, microorganisms and fleas were incubated and monitored in different concentrations of antibiotics. Gentamicin, sufamethoxazole, trimethoprim were useful for R. typhi isolation. Gentamicin, streptomycin, penicillin, and amphotericin B were useful for R. felis isolation. Finally, the optimized conditions were used to isolate R. felis from fleas collected at a veterinary clinic. R. felis was isolated at 28 and 32 °C. However, successful establishment of cultures were not possible probably due to sub-optimal conditions of samples.

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Murine typhus in Tunisia: A neglected cause of fever as a single symptom

Cited by 14 publications

References 25 publications

Severe Murine Typhus with Pulmonary System Involvement

Severe Murine Typhus with Pulmonary System Involvement

Noneruptive Fever Revealing Murine Typhus in a Traveler Returning From Tunisia

Shell-vial culture and real-time PCR applied to Rickettsia typhi and Rickettsia felis detection

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