Severe Murine Typhus with Pulmonary System Involvement

Vaart, Thomas W. van der; Thiel, Pieter P. A. M. van; Juffermans, Nicole P.; Vugt, Michèle van; Geerlings, Suzanne E.; Grobusch, Martin P.; Goorhuis, Abraham

doi:10.3201/eid2008.131421

Cited by 28 publications

(19 citation statements)

References 13 publications

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“…Neurologic manifestations were also seen in more than half of the patients for whom additional data were available, and previous literature has described neurologic manifestations in 15–45% of patients 17,18. Our findings are consistent with previous literature and suggest that respiratory and neurologic complications from R. typhi infection may occur frequently in severe cases 6,16,18–21. The frequency of respiratory and neurologic manifestations identified in this series may have been confounded by the advanced stage of disease that patients presented at initial hospital presentation.…”

Section: Discussionsupporting

confidence: 91%

“…The frequency of respiratory manifestations have been recognized for many years; indeed, an early summary of flea-borne typhus in Texas noted, “few diseases present so much subjective respiratory symptoms with so little objective findings.”15 Previous literature reported 14–59% of flea-borne typhus patients had respiratory symptoms 12,16,17. Neurologic manifestations were also seen in more than half of the patients for whom additional data were available, and previous literature has described neurologic manifestations in 15–45% of patients 17,18.…”

Section: Discussionmentioning

confidence: 99%

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Fatal Flea-Borne Typhus in Texas: A Retrospective Case Series, 1985–2015

Pieracci

Evert

Drexler

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Flea-borne (murine) typhus is a global rickettsiosis caused by Rickettsia typhi. Although flea-borne typhus is no longer nationally notifiable, cases are reported for surveillance purposes in a few U.S. states. The infection is typically self-limiting, but may be severe or life-threatening in some patients. We performed a retrospective review of confirmed or probable cases of fatal flea-borne typhus reported to the Texas Department of State Health Services during 1985–2015. When available, medical charts were also examined. Eleven cases of fatal flea-borne typhus were identified. The median patient age was 62 years (range, 36–84 years) and 8 (73%) were male. Patients presented most commonly with fever (100%), nausea and vomiting (55%), and rash (55%). Respiratory (55%) and neurologic (45%) manifestations were also identified frequently. Laboratory abnormalities included thrombocytopenia (82%) and elevated hepatic transaminases (63%). Flea or animal contact before illness onset was frequently reported (55%). The median time from hospitalization to administration of a tetracycline-class drug was 4 days (range, 0–5 days). The median time from symptom onset to death was 14 days (range, 1–34 days). Flea-borne typhus can be a life-threatening disease if not treated in a timely manner with appropriate tetracycline-class antibiotics. Flea-borne typhus should be considered in febrile patients with animal or flea exposure and respiratory or neurologic symptoms of unknown etiology.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Fatal Flea-Borne Typhus in Texas: A Retrospective Case Series, 1985–2015

Pieracci

Evert

Drexler

et al. 2017

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

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“…However, as the patient also had underlying interstitial pulmonary fibrosis and precipitated by the existing lung pathology, it is difficult to conclude that her respiratory problems were solely related to murine typhus. Severe pulmonary manifestations of murine typhus are rare, 28 but has been reported from travelers returning from Thailand 29 and Indonesia. 30 It has been reported that elderly patients have more severe clinical manifestations, as evidenced by a higher complication rate and longer duration of fever.…”

Section: Discussionmentioning

confidence: 99%

Spotted Fever Group Rickettsioses and Murine Typhus in a Malaysian Teaching Hospital

Kho

Koh

Singh

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Limited information is available on the etiological agents of rickettsioses in southeast Asia. Herein, we report the molecular investigation of rickettsioses in four patients attending a teaching hospital in Malaysia. DNA of Rickettsia sp. RF2125, Rickettsia typhi, and a rickettsia closely related to Rickettsia raoultii was detected in the blood samples of the patients. Spotted fever group rickettsioses and murine typhus should be considered in the diagnosis of patients with nonspecific febrile illness in this region.

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“…Compared to a hospitalization rate of about 10% in SFG-patients, hospitalization rate in travelers with scrub typhus or murine typhus can reach 37 or 50% respectively [6, 15]. Similarly to what is observed in the spotted fever group [18], complications as diverse as hematophagocytic syndrome, myocarditis, shock, renal failure, acute respiratory distress syndrome or encephalitis have been reported in travelers presenting with murine [1, 19–21] or scrub typhus [22–24]. Mortality rates are generally low (0–6%) in high-resource settings [6, 15], even in case of diagnostic delay, but remain substantial in most endemic areas [25, 26].…”

Section: Discussionmentioning

confidence: 99%

Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report

et al. 2017

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BackgroundRickettsiosis is a potential life threatening infectious disease in travelers. Clinical recognition is not always straightforward, as typical manifestations such as rash and/or eschar may be absent. Definite diagnosis is based on seroconversion and therefore often delayed until the convalescent phase of disease.Case presentationIn this case report, we describe four patients with severe travel-related rickettsiosis (two patients with murine- and two patients with scrub typhus), in whom acute- phase diagnosis was possible by real-time polymerase chain reaction on serum or blood.ConclusionsDespite its limitations, we think that polymerase chain reaction can contribute significantly to the early diagnosis and treatment of rickettsial disease in travelers.

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Severe Murine Typhus with Pulmonary System Involvement

Cited by 28 publications

References 13 publications

Fatal Flea-Borne Typhus in Texas: A Retrospective Case Series, 1985–2015

Fatal Flea-Borne Typhus in Texas: A Retrospective Case Series, 1985–2015

Spotted Fever Group Rickettsioses and Murine Typhus in a Malaysian Teaching Hospital

Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report

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