An Unusual Cutaneous Manifestation in a Patient with Murine Typhus

Blanton, Lucas S.; Lea, Alfred; Kelly, Brent; Walker, David H.

doi:10.4269/ajtmh.15-0380

Cited by 15 publications

(9 citation statements)

References 18 publications

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“… 6 7 With the current pandemic, it has become even more important for clinicians to recognise other illnesses that present with persistent fever. 8 9 The differential diagnoses of persistent febrile illness range from malignancy to infectious diseases to rheumatological conditions. A comprehensive history including occupation, travel or exposure to animals may lead to diagnoses of under-reported febrile illnesses such as murine typhus.…”

Section: Introductionmentioning

confidence: 99%

Murine typhus mistaken for COVID-19 in a young man

Patel

2020

BMJ Case Rep

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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.

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Section: Introductionmentioning

confidence: 99%

Murine typhus mistaken for COVID-19 in a young man

Patel

2020

BMJ Case Rep

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“…Newly described complications in this series included pancreatitis, myositis, and rhabdomyolysis. Unusual cutaneous manifestations ( 21 ), iritis ( 20 ), lymphadenopathy ( 20 ), splenic rupture ( 22 , 23 ), disseminated intravascular coagulation ( 3 , 12 ), cholecystitis ( 24 ), and endocarditis ( 25 , 26 ) have previously been reported; except for 1 patient with cholecystitis, we had no examples of these other unusual complications in our series.…”

Section: Discussionmentioning

confidence: 64%

Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1^,2

Afzal¹,

Kallumadanda²,

Wang³

et al. 2017

Emerg. Infect. Dis.

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Murine typhus occurs relatively commonly in southern Texas, as well as in California. We reviewed records of 90 adults and children in whom murine typhus was diagnosed during a 3-year period in 2 hospitals in southern Texas, USA. Most patients lacked notable comorbidities; all were immunocompetent. Initial signs and symptoms included fever (99%), malaise (82%), headache (77%), fatigue (70%), myalgias (68%), and rash (39%). Complications, often severe, in 28% of patients included bronchiolitis, pneumonia, meningitis, septic shock, cholecystitis, pancreatitis, myositis, and rhabdomyolysis; the last 3 are previously unreported in murine typhus. Low serum albumin and elevated procalcitonin, consistent with bacterial sepsis, were observed in >70% of cases. Rash was more common in children; thrombocytopenia, hyponatremia, elevated hepatic transaminases, and complications were more frequent in adults. Murine typhus should be considered as a diagnostic possibility in cases of acute febrile illness in southern and even in more northern US states.

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“…Of the patients with murine typhus, 13 (56.5%) were confirmed and 10 (43.5%) were considered probable. Of the confirmed cases, one was diagnosed via culture and blood PCR (as reported in detail elsewhere), 6 one via 4-fold increase in indirect immunofluorescense assay (IFA) titer and PCR of a skin sample (as reported in detail elsewhere), 22 and the remaining via 4-fold increase in the IFA titer. Among the 69 with influenza, 60 (87.0%) had influenza A and 9 (13.0%) had influenza B.…”

Section: Resultsmentioning

confidence: 99%

Analysis of Health-Care Charges in Murine Typhus: Need for Improved Clinical Recognition and Diagnostics for Acute Disease

Vohra

Walker

Blanton

2018

The American Journal of Tropical Medicine and Hygiene

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Murine typhus, caused by , is an undifferentiated febrile illness with no available rapid and sensitive diagnostic assay for use during early disease. We aimed to compare the health-care charges in those diagnosed with murine typhus to those with influenza, a febrile illness with an available rapid diagnostic test. A comparison of health-care-associated charges at the University of Texas Medical Branch at Galveston demonstrated a median of $817 for influenza versus $16,760 for murine typhus ( < 0.0001). Median laboratory ($184 versus $3,254 [ < 0.0001]) and imaging charges ($0 versus $514 [ < 0.0001]) were also higher in those with murine typhus. Those receiving at least one imaging study during their illness were greater in the murine typhus group (91.3% versus 20.3%) ( < 0.0001). The median time needed to establish a confirmed or presumptive diagnosis was 2 days for influenza compared with 9 days for murine typhus ( < 0.0001). The median number of health-care encounters was greater for those with murine typhus (2 versus 1) ( < 0.0001). Eleven patients (15.9%) with influenza were hospitalized as a result of their illness compared with 16 (69.6%) with murine typhus ( < 0.0001). The estimated mortality based on disease severity at presentation by Acute Physiology and Chronic Health Evaluation II scoring was similar in the two groups-both had a median 4% mortality risk ( = 0.0893). These results highlight the need for improved clinical recognition and diagnostics for acute rickettsioses such as murine typhus.

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An Unusual Cutaneous Manifestation in a Patient with Murine Typhus

Cited by 15 publications

References 18 publications

Murine typhus mistaken for COVID-19 in a young man

Murine typhus mistaken for COVID-19 in a young man

Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1^,2

Analysis of Health-Care Charges in Murine Typhus: Need for Improved Clinical Recognition and Diagnostics for Acute Disease

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An Unusual Cutaneous Manifestation in a Patient with Murine Typhus

Cited by 15 publications

References 18 publications

Murine typhus mistaken for COVID-19 in a young man

Murine typhus mistaken for COVID-19 in a young man

Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1,2

Analysis of Health-Care Charges in Murine Typhus: Need for Improved Clinical Recognition and Diagnostics for Acute Disease

Contact Info

Product

Resources

About

Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1^,2