Typhus Group Rickettsiosis, Germany, 2010–20171

Abstract

Typhus group rickettsiosis is caused by the vectorborne bacteria Rickettsia typhi and R. prowazekii. R. typhi, which causes murine typhus, the less severe endemic form of typhus, is transmitted by fleas; R. prowazekii, which causes the severe epidemic form of typhus, is transmitted by body lice. To examine the immunology of human infection with typhus group rickettsiae, we retrospectively reviewed clinical signs and symptoms, laboratory changes, and travel destinations of 28 patients who had typhus group rickettsiosis diagnosed by the German Reference Center for Tropical Pathogens, Hamburg, Germany, during 2010–2017. Immunofluorescence assays of follow-up serum samples indicated simultaneous seroconversion of IgM, IgA, and IgG or concurrence in the first serum sample. Cytokine levels peaked during the second week of infection, coinciding with organ dysfunction and seroconversion. For 3 patients, R. typhi was detected by species-specific nested quantitative PCR. For all 28 patients, R. typhi was the most likely causative pathogen.

Case Report: Renal Failure due to Focal Segmental Glomerulosclerosis in a Patient with Murine Typhus

“…15 As documented in both humans and animal models, infection with R. typhi is associated with elevated IFN-γ. 20,21 The mean value of IFN-γ in those with murine typhus has been reported to be approximately 600 pg/mL (during the acute phase of illness). 21 To compare with two other prevalent undifferentiated febrile illnesses, dengue and malaria, mean IFN-γ levels have been reported to be approximately 25 pg/mL and 231 pg/mL, respectively.…”

Rickettsia typhias Cause of Fatal Encephalitic Typhus in Hospitalized Patients, Hamburg, Germany, 1940–1944

“…We performed panrickettsial real-time qPCRs targeting the ompB and gltA genes ( 4 , 5 ). In addition, we used a typhus group rickettsiae–specific qPCR targeting the rpr331 gene ( 6 ) and nested species-specific qPCRs detecting the prsA genes ( 7 , 8 ) of the R. typhi and R. prowazekii genomes ( Technical Appendix Table). We ran a β-actin gene qPCR ( 9 ) in parallel to check DNA quality.…”

Manifestations and Management of Flea-Borne Rickettsioses

“…Occasionally, severe manifestations occur; a case series from Germany, which included 28 patients, found 18% had severe manifestations (eg, pneumonitis, acute kidney injury, and central nervous system involvement). 134 Pulmonary involvement, in the form of dry cough, occurs in 27% of those with murine typhus, 125 and infiltrates on chest imaging occurs in 17% of cases. 135 Progression to acute respiratory distress syndrome, albeit infrequent, has been reported.…”