Clinical and Laboratory Features of Murine Typhus in South Texas, 1980 Through 1987

Abstract

--Infection by Rickettsia typhi causes a systemic illness with clinical and laboratory abnormalities not previously recognized or described. Early clinical diagnosis and treatment are needed to avoid undue morbidity and mortality.

Murine Typhus in Returned Travelers: A Report of Thirty-Two Cases

“…2 The classic triad consists of fever, headache, and rash and was found in 18% of the adult patients who presented in the series in Texas, whereas the triad was found in 49% of the patients in a pediatric series in Texas. 22,23 Our results were similar to the findings of Dumler and others 23 ; this triad cannot be considered to be a pathognomonic sign because it is inconsistent. The hemophagocytic syndrome occurred in three cases, but all the diagnostic criteria could be obtained in only one case.…”

“…In a large study of murine typhus, 2% of the patients had life-threatening cases that resulted in three deaths, including two patients with multi-organ failure. 23 One fatal case involved a woman who, during a trip to Spain, presented with multi-organ failure and hemorrhagic syndrome. 25 In our series, despite a case of septic shock and a case of myocarditis, no deaths were observed.…”

“…Mortality in the absence of antibiotic therapy has been reported up to 4% of cases. 23 Murine typhus could be confused with various infectious diseases, including malaria. Therefore specific antibiotic treatment is necessary.…”

An Unusual Cutaneous Manifestation in a Patient with Murine Typhus

“…In 10 large case series describing 841 patients with murine typhus, rash was found in 59%, but no localized inoculationtype lesions, similar to the one described here, were reported. [4][5][6][7][8][9][10][11][12][13] In a guinea pig model of R. typhi infection, intradermal inoculation of the organism resulted in cutaneous erythema, induration, and necrosis. 18 In another animal model, intended to predict eschar formation following infection with various rickettsial species, R. typhi failed to produce eschars in intradermally inoculated guinea pigs-a finding which the authors state is consistent with what is known clinically of typhus group rickettsioses in humans.…”

“…3 The disease presents as an undifferentiated febrile illness accompanied by a maculopapular rash in 59% of infected persons. [4][5][6][7][8][9][10][11][12][13] Unlike many spotted fever group rickettsioses (SFGR) and scrub typhus, infection caused by R. typhi is not associated with an inoculation lesion. We herein describe a patient with murine typhus and an unusual clinical feature at the site of rickettsial inoculation.…”