Case Report: Early Doxycycline Therapy for Potential Rickettsiosis in Critically Ill Patients in Flea-Borne Typhus-Endemic Areas

Chueng, Teresa A.; Koch, Kristopher R.; Anstead, Gregory M.; Agarwal, Apeksha N.; Dayton, Christopher L.

doi:10.4269/ajtmh.19-0118

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…Streptococcus pneumoniae and legionella pneumophila urine antigens, thyroid hormones, cortisol and toxicology screening were also part of the diagnostic workup described by some authors [ 35 , 36 , 72 ]. Serology for rickettsial infections, screening for schistosomiasis, leishmaniasis were used in areas, where the pathogens are endemic [ 37 , 42 ]. Interestingly, malaria screening may be warranted even when patients have not travelled to endemic areas as rare events may allow vector borne diseases to transmit in non-endemic areas [ 73 ].…”

Section: Resultsmentioning

confidence: 99%

“…QuantiFERON-TB Gold to screen for mycobacterium tuberculosis was mentioned in one study [ 74 ]. Five studies mentioned the need for human immunodeficiency virus testing [ 25 , 37 , 39 , 42 , 53 ]. Procalcitonin was tested in 10/89 (11%) studies as a marker suggestive of bacterial sepsis, although it cannot help to localize the site of infection [ 18 , 30 , 34 , 38 , 41 , 52 , 62 , 65 , 66 , 75 ].…”

Section: Resultsmentioning

confidence: 99%

“…Despite the universal absence of history as a component of the diagnostic criteria for SUO (when provided), 30/89 (34%) of studies discussed the merits of specific, focused history taking. Most of these studies describe how a particular aspect of history helped direct further investigations to confirm the infective source or to suggest alternative diagnoses [34][35][36][37][38][39][40]. Important aspects of history taking included travel history which may reveal exposure to endemic pathogens, such as malaria and rickettsia [34,37].…”

Section: Historymentioning

confidence: 99%

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Scoping review on diagnostic criteria and investigative approach in sepsis of unknown origin in critically ill patients

Mui

Lefrant

Stelfox³

et al. 2022

j intensive care

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Background Up to 11% of critically ill patients with sepsis have an unknown source, where the pathogen and site of infection are unclear. The aim of this scoping review is to document currently reported diagnostic criteria of sepsis of unknown origin (SUO) and identify the types and breadth of existing evidence supporting diagnostic processes to identify the infection source in critically ill patients with suspected SUO. Methods A literature search of Embase, MEDLINE and PubMed for published studies from 1910 to August 19, 2021 addressing the topic of SUO was performed. Study type, country of origin according to World Bank classification, diagnostic criteria of sepsis of unknown origin, and investigative approaches were extracted from the studies. Results From an initial 722 studies, 89 unique publications fulfilled the inclusion and exclusion criteria and were included for full text review. The most common publication type was case report/series 45/89 (51%). Only 10/89 (11%) of studies provided a diagnostic criteria of SUO, but a universally accepted diagnostic criterion was not identified. The included studies discussed 30/89 (34%) history, 23/89 (26%) examination, 57/89 (64%) imaging, microbiology 39/89 (44%), and special tests 32/89 (36%) as part of the diagnostic processes in patients with SUO. Conclusions Universally accepted diagnostic criteria for SUO was not found. Prospective studies on investigative processes in critically ill patients managed as SUO across different healthcare settings are needed to understand the epidemiology and inform the diagnostic criteria required to diagnose SUO.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Historymentioning

confidence: 99%

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Scoping review on diagnostic criteria and investigative approach in sepsis of unknown origin in critically ill patients

Mui

Lefrant

Stelfox³

et al. 2022

j intensive care

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“…Other ocular manifestations of FBT are rarely appreciated. Isolated cases of retinitis [61,62], optic neuritis [63,64], hemorrhagic conjunctivitis [65], and uveitis [66] have been reported in FBT. However, in a prospective study of nine consecutive FBT patients who received a comprehensive ophthalmologic evaluation, three patients had ocular signs and symptoms.…”

Section: Lymphatic and Ocular Involvement In Flea-borne Typhusmentioning

confidence: 99%

Parinaud’s Oculoglandular Syndrome: A Case in an Adult with Flea-Borne Typhus and a Review

Dixon

Dayton²,

Anstead

2020

TropicalMed

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Parinaud’s oculoglandular syndrome (POGS) is defined as unilateral granulomatous conjunctivitis and facial lymphadenopathy. The aims of the current study are to describe a case of POGS with uveitis due to flea-borne typhus (FBT) and to present a diagnostic and therapeutic approach to POGS. The patient, a 38-year old man, presented with persistent unilateral eye pain, fever, rash, preauricular and submandibular lymphadenopathy, and laboratory findings of FBT: hyponatremia, elevated transaminase and lactate dehydrogenase levels, thrombocytopenia, and hypoalbuminemia. His condition rapidly improved after starting doxycycline. Soon after hospitalization, he was diagnosed with uveitis, which responded to topical prednisolone. To derive a diagnostic and empiric therapeutic approach to POGS, we reviewed the cases of POGS from its various causes since 1976 to discern epidemiologic clues and determine successful diagnostic techniques and therapies; we found multiple cases due to cat scratch disease (CSD; due to Bartonella henselae) (twelve), tularemia (ten), sporotrichosis (three), Rickettsia conorii (three), R. typhi/felis (two), and herpes simplex virus (two) and single cases due to tuberculosis, paracoccidioidomycosis, Yersinia enterocolitica, Pasteurella multocida, Chlamydia trachomatis, Epstein–Barr virus, and Nocardia brasiliensis. Preauricular lymphadenopathy is a common clinical clue for POGS and is unusual in viral and bacterial conjunctivitis. For POGS, the major etiological consideration is B. henselae, which is usually diagnosed by the indirect immunofluorescence serologic technique. Although CSD POGS is usually self-limited, oral azithromycin may hasten resolution. However, other possible etiologies of POGS may also arise from cat or cat flea contact: sporotrichosis, tularemia, Pasteurella multocida, or FBT. If there is no cat contact, other epidemiologic and clinical findings should be sought, because several of these conditions, such as tularemia, paracoccidioidomycosis, and tuberculosis, may have grave systemic complications. Although there are usually no long-term ocular sequelae if POGS is properly diagnosed, it still may cause prolonged ocular discomfort and require multiple physician contacts.

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“…The infection causes fever, headache, rash, and diverse organ manifestations. While most cases are self-limited, 26–28% have complications and up to one-third require intensive care [ 1 ]. Flea-borne typhus is transmitted to humans by the inoculation of a bite site, a skin abrasion, or mucous membranes with feces from fleas infected with these rickettsiae or by a flea-bite [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

History, Rats, Fleas, and Opossums. II. The Decline and Resurgence of Flea-Borne Typhus in the United States, 1945–2019

Anstead

2020

TropicalMed

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Flea-borne typhus, due to Rickettsia typhi and R. felis, is an infection causing fever, headache, rash, and diverse organ manifestations that can result in critical illness or death. This is the second part of a two-part series describing the rise, decline, and resurgence of flea-borne typhus (FBT) in the United States over the last century. These studies illustrate the influence of historical events, social conditions, technology, and public health interventions on the prevalence of a vector-borne disease. Flea-borne typhus was an emerging disease, primarily in the Southern USA and California, from 1910 to 1945. The primary reservoirs in this period were the rats Rattus norvegicus and Ra. rattus and the main vector was the Oriental rat flea (Xenopsylla cheopis). The period 1930 to 1945 saw a dramatic rise in the number of reported cases. This was due to conditions favorable to the proliferation of rodents and their fleas during the Depression and World War II years, including: dilapidated, overcrowded housing; poor environmental sanitation; and the difficulty of importing insecticides and rodenticides during wartime. About 42,000 cases were reported between 1931–1946, and the actual number of cases may have been three-fold higher. The number of annual cases of FBT peaked in 1944 at 5401 cases. American involvement in World War II, in the short term, further perpetuated the epidemic of FBT by the increased production of food crops in the American South and by promoting crowded and unsanitary conditions in the Southern cities. However, ultimately, World War II proved to be a powerful catalyst in the control of FBT by improving standards of living and providing the tools for typhus control, such as synthetic insecticides and novel rodenticides. A vigorous program for the control of FBT was conducted by the US Public Health Service from 1945 to 1952, using insecticides, rodenticides, and environmental sanitation and remediation. Government programs and relative economic prosperity in the South also resulted in slum clearance and improved housing, which reduced rodent harborage. By 1956, the number of cases of FBT in the United States had dropped dramatically to only 98. Federally funded projects for rat control continued until the mid-1980s. Effective antibiotics for FBT, such as the tetracyclines, came into clinical practice in the late 1940s. The first diagnostic test for FBT, the Weil-Felix test, was found to have inadequate sensitivity and specificity and was replaced by complement fixation in the 1940s and the indirect fluorescent antibody test in the 1980s. A second organism causing FBT, R. felis, was discovered in 1990. Flea-borne typhus persists in the United States, primarily in South and Central Texas, the Los Angeles area, and Hawaii. In the former two areas, the opossum (Didelphis virginiana) and cats have replaced rats as the primary reservoirs, with the cat flea (Ctenocephalides felis) now as the most important vector. In Hawaii, 73% of cases occur in Maui County because it has lower rainfall than other areas. Despite great successes against FBT in the post-World War II era, it has proved difficult to eliminate because it is now associated with our companion animals, stray pets, opossums, and the cat flea, an abundant and non-selective vector. In the new millennium, cases of FBT are increasing in Texas and California. In 2018–2019, Los Angeles County experienced a resurgence of FBT, with rats as the reservoir.

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Case Report: Early Doxycycline Therapy for Potential Rickettsiosis in Critically Ill Patients in Flea-Borne Typhus-Endemic Areas

Cited by 7 publications

References 26 publications

Scoping review on diagnostic criteria and investigative approach in sepsis of unknown origin in critically ill patients

Scoping review on diagnostic criteria and investigative approach in sepsis of unknown origin in critically ill patients

Parinaud’s Oculoglandular Syndrome: A Case in an Adult with Flea-Borne Typhus and a Review

History, Rats, Fleas, and Opossums. II. The Decline and Resurgence of Flea-Borne Typhus in the United States, 1945–2019

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