Murine typhus mistaken for COVID-19 in a young man

Abstract

Fever is a widely recognised presenting symptom of COVID-19. Consequently, other febrile illnesses may be difficult to distinguish from COVID-19—leading to delays in diagnosis and treatment. One such illness is murine typhus, a fleaborne illness with worldwide distribution caused by Rickettsia typhi. It often presents with fever, headache and myalgia, all of which have been commonly reported with COVID-19. Although the disease is usually mild with a good prognosis, there have been reports of severe illness and death. I present a case of murine typhus in a young male who had 2 weeks of headaches and daily fevers during the COVID-19 pandemic. He was ultimately tested for murine typhus when his occupation as a dog trainer was queried, and he experienced resolution of symptoms after treatment with doxycycline. During this pandemic, clinicians must be vigilant of other febrile illnesses whose symptoms overlap with COVID-19.

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.…”

Diagnostic bias during the COVID-19. A rare case report of salmonella typhi

“…Also, fever is a well-known sign of COVID-19 infection which has been observed in 83%–98% of patients with COVID19. As a result, it may be difficult to tell the difference between COVID-19 and other febrile infections, causing delays in diagnosis and treatment and may blind the physician from considering other febrile illnesses [ 16 ]. Furthermore, the present case depends on the clinical finding of fever, headache and myalgia previously diagnosed as COVID-19.…”

“…Malignancy, viral disorders, and rheumatological problems are among the differential diagnoses for chronic febrile sickness. A thorough medical history, including work, travel, and animal contact, may lead to the diagnosis of previously undiagnosed febrile diseases [ 16 , 18 ]. The current case history helped physicians to suspect Typhoid fever.…”

Infezioni in Medicina

“…After two weeks of symptomatology, murine typhus was suspected due to a history of working as a dog trainer. Serology evidenced titers above 1:256, for which doxycycline was given, and the patient finally recovered [15]. reliosis and Anaplasma phagocytophilum were also evaluated, but both resulted negative.…”