Murine Typhus in Austin, Texas, USA, 2008

Adjemian, Jennifer; Parks, Sharyn E.; McElroy, Kristina; Campbell, Jill; Eremeeva, Marina E.; Nicholson, William L.; McQuiston, Jennifer H.; Taylor, Jeffery P.

doi:10.3201/eid1603.091028

Cited by 86 publications

(82 citation statements)

References 17 publications

(33 reference statements)

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“…9 Since then, opossums and their fleas (C. felis) have been implicated as a presumed reservoir-vector source, which fuels the remaining foci of endemicity in the United States. 5,9,10,24,25 In Galveston, as in the rest of the country, the incidence of murine typhus sharply decreased with the dusting of rat runs with DDT. 8 Even after discontinuation of the pesticide due to environmental concerns, the disruption of the disease cycle seemed to have lasting effects.…”

Section: Discussionmentioning

confidence: 99%

“…When murine typhus made an apparent reappearance in Galveston, we could not help but wonder if the alternate cycle of transmission had a role in its reemergence. After all, opossums and C. felis fleas have been linked to cases of murine typhus in a city with longstanding endemicity (Corpus Christi, TX) 11,12 and in a city with a recent outbreak (Austin, TX) 5 -both of which are only 220 miles from Galveston.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 In the investigation, which described an outbreak of murine typhus in Austin, 70.6%, 47.1%, and 29.4% of opossums were reported to be seropositive at minimum reciprocal IFA IgG titers of 32, 64, and 128, respectively. 5 In California, the seroprevalence rates in opossums trapped in the vicinity of human murine typhus cases have varied. The aforementioned study by Adams and others, which first implicated opossums and their fleas as a potential culprit, found 10.7% of opossums were seropositive for typhus group antibodies.…”

Section: Discussionmentioning

confidence: 99%

“…3 Although often ignored or deemed irrelevant as a cause of febrile illness, murine typhus continues to emerge as a cause of illness in communities in the United States. [4][5][6] It has also been increasingly recognized as a cause of fever in returning travelers. 2 In 1944, the number of murine typhus cases in the United States reached a peak of 5,401 and experienced a precipitous decline in the years following.…”

Section: Introductionmentioning

confidence: 99%

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Opossums and Cat Fleas: New Insights in the Ecology of Murine Typhus in Galveston, Texas

Blanton

Idowu

Tatsch

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Murine typhus is an acute undifferentiated febrile illness caused by Rickettsia typhi. The classic reservoir (Rattus spp.) and flea vector (Xenopsylla cheopis) were once culprits of murine typhus in the United States. Vector and rodent control efforts have drastically decreased the prevalence of disease, except in a few endemic foci where opossums and cat fleas play a role in transmission. Since 2012, there has been a reemergence of murine typhus in Galveston, TX. We hypothesize that opossums and cat fleas are involved in the transmission of R. typhi in Galveston. To explore this, we sought to find the seroprevalence of typhus group antibodies from opossums. We also sought to find the prevalence of R. typhi in fleas parasitizing these animals. We collected blood from 12 opossums and found that eight (66.7%) had the presence of anti-R. typhi antibodies. All opossums were infested with fleas; a total of 250 Ctenocephalides felis fleas were collected from these animals. Seven opossums (53.8%) were infested with fleas that had molecular evidence of R. typhi infection, while six (46.2%) were infested with fleas that contained Candidatus Rickettsia senegalensis, an organism closely related to R. felis. The minimum flea infection rate for R. typhi was 7.0%. The minimum infection rate for Candidatus R. senegalensis was 6.1%. Our study demonstrates that fleas infected with R. typhi parasitize opossums in Galveston. It is therefore likely that opossums and their fleas play a role in the city's recent reemergence of murine typhus.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Opossums and Cat Fleas: New Insights in the Ecology of Murine Typhus in Galveston, Texas

Blanton

Idowu

Tatsch

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…12 The most common symptoms were fever (98-100%), headache (41-90%), arthralgia (40-77%), and rash (20-80%). The rash is classically described as faint and maculopapular, with an initial central distribution starting on the trunk and spreading peripherally but sparing the palms and soles.…”

mentioning

confidence: 99%

Severe Typhus Group Rickettsiosis Complicated by Pulmonary Edema in a Returning Traveler from Indonesia

Stockdale

Weekes²,

Kiely³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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A 29-year-old man presented with an 8-day history of fever, rigors, drenching night sweats, myalgia, and severe frontal headache. He subsequently developed a dry cough with shortness of breath on exertion and a maculopapular rash 2 days before presentation to hospital.He had returned 11 days previously from a holiday that initially comprised 2 weeks in Bali and Lombok, Indonesia, and then 7 days in Hong Kong. He had visited both urban and rural environments and described exposure to fresh water, sea water, and hot springs. He had sustained lacerations to both feet from coral while scuba diving. He reported frequently seeing rats in his living environment, including in his accommodation. He denied any contact with animals. He sustained multiple insect bites, including presumptive mosquito bites, but no tick bites.He had been vaccinated against Salmonella typhi and hepatitis A and was taking atovaquone/proguanil (Malarone ® GlaxoSmithKline, Brentford, Middlesex, United Kingdom) for antimalarial prophylaxis. His only past history comprised wellcontrolled asthma , and he took no regular medicines.On examination, he appeared unwell and was pyrexial at 39.6°C (103°F). He had conjunctival injection and a faint maculopapular rash confined to both arms, with sparing of the palms that resolved rapidly over the next 2 days. Respiratory examination revealed bibasal crepitations. The liver was palpable 1 cm below the costal margin, splenomegaly was noted, and a few subcentimetrer tender cervical lymph nodes were palpable.Blood tests on admission showed a normal white cell count of 6.1 × 10 9 /L, (differential: neutrophils = 4.6, lymphocytes = 0.6, monocytes = 0.4, and eosinophils = 0.01 × 10 9 /L), platelets at 78 × 10 9 /L, and hemoglobin at 13.8 g/dL. Sodium (Na) was 132 mmol/L, potassium (K) was 4.1 mmol/L, creatinine was 124 μmol/L, albumin (alb) was 31 g/L, bilirubin was 60 μmol/L, alkaline phosphatase (ALP) was 264 U/L, alanine transaminase (ALT) was 340 U/L, and C-reactive protein > 250 mg/L ( Figure 1 shows trends). Three malaria films and histidine-rich protein-2 (HRP-2) antigen were negative. Serology for human immunodeficiency virus (HIV) and hepatitis A, B, and C were negative. Admission chest X-ray was normal, but a repeat X-ray 3 days later showed bibasal reticulonodular shadowing consistent with pulmonary edema. Abdominal ultrasound showed a normal liver and biliary tree with an enlarged spleen at 15 cm.Our differential diagnosis included rickettsiosis, leptospirosis, typhoid, and legionella. Accordingly, he was initially treated with doxycycline, clarithromycin, and piperacillin/tazobactam ( Figure 1 ). After 1 day, piperacillin/tazobactam was switched to ceftriaxone because of failure to improve. After 2 days, he was clinically worse, with persistent pyrexia and diminishing oxygen saturations. He needed supplemental oxygen for the next 3 days ( Figure 1 ). Ceftriaxone was empirically switched to meropenem. Doxycycline was continued throughout. It took a total of 4 days for the fever to settle and clinical i...

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Murine Typhus

Blanton

2021

Neglected Tropical Diseases

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Murine Typhus in Austin, Texas, USA, 2008

Abstract: Physicians should be alert for possible cases in this area.

Cited by 86 publications

References 17 publications

Opossums and Cat Fleas: New Insights in the Ecology of Murine Typhus in Galveston, Texas

Opossums and Cat Fleas: New Insights in the Ecology of Murine Typhus in Galveston, Texas

Severe Typhus Group Rickettsiosis Complicated by Pulmonary Edema in a Returning Traveler from Indonesia

Murine Typhus

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