Murine Typhus Infection in Pregnancy: Case Series and Literature Review

Tanabe, Melinda B.; Blanton, Lucas S.; Rosa, Mauricio La; Webb, Camille M.

doi:10.3390/pathogens10020219

Cited by 6 publications

(6 citation statements)

References 33 publications

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“…The interactive illustration has been created using Tableau software (Version 2023) [15] and available from the link: https://bit.ly/fetal_outcome. This shows that most reports of scrub typhus are from Southeast Asia including 14 studies from India [3][4][5]16-26], 5 from Thailand [27][28][29][30][31] and 2 from Korea [32,33] and one each from Bhutan [34], Laos [13] and China [35] whereas the reports of other Rickettsia infections like murine typhus and Rocky Mountain spotted fever are more prevalent in USA [36][37][38][39][40]. On the other hand, there is no speci c geographical distribution of the cases of leptospirosis.…”

Section: Resultsmentioning

confidence: 99%

Foetal outcome of Leptospira and Rickettsial infections during pregnancy: A Systematic Review

Sengupta,

Mandal

et al. 2023

Preprint

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Background – Leptospirosis and Rickettsial infections including scrub typhus are murine typhus are bacterial zoonosis prevalent in different geographical locations. This systematic review aims to identify foetal outcome in pregnant woman diagnosed with Rickettsial infection including scrub typhus and leptospirosis along with its associated factors. Methods - A comprehensive search was done in MEDLINE/PubMed, Scopus, CENTRAL (Cochrane), Web of Science, PsycInfo, Academic Search Premier, CINAHL, and Embase using a defined search term. The selection criteria were studies having pregnant women with diagnosed leptospirosis and Rickettsial infections including scrub typhus. The studies were excluded based on - diagnosis not clear, animal study, in vitro study, no pregnant population, co-infection, other infection except those concerned, seroprevalence without any foetal outcome. Studies in language other than English were also excluded. The initial screening of titles and abstracts was conducted by two independent reviewers using the Rayyan Web interface. Discrepancies were resolved through discussion or consultation with a third reviewer. Full-text review was carried out by the two reviewers, with disagreements resolved similarly. Data extraction was performed in Microsoft Excel, aided by Zotero for reference management. The assessment of study quality utilized The Joanna Briggs Institute Critical Appraisal tools. Data synthesis and analysis included a narrative synthesis of findings. Main results – A total of 54 studies were included in the systematic review for analysis. Among the 54 studies included in the systematic review, 22 had data on only scrub typhus, 14 had data on only Rickettsial infection, 16 had data on leptospirosis and 2 studies had data on all three infections. A total of 176 cases of scrub typhus were included with foetal loss in 53 (30.11%) and neonatal death in 3 (1.7%). Among the 38 cases of Rickettsial infection, 4 (10.5%) had foetal loss. Out of the total 63 cases of leptospirosis 13 (20.6%) had foetal loss. There were 6 maternal deaths due to scrub typhus and one maternal death due to Rocky Mountain spotted fever. Conclusion – Leptospirosis and Rickettsial infections including scrub typhus are important causes of loss of pregnancy. Hence diagnosis and appropriate management of these cases in pregnancy is essential.

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Section: Resultsmentioning

confidence: 99%

Foetal outcome of Leptospira and Rickettsial infections during pregnancy: A Systematic Review

Sengupta,

Mandal

et al. 2023

Preprint

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“…However, ciprofloxacin failures have been reported [ 44 ]. Azithromycin has been primarily used to treat FBT during pregnancy [ 45 ], but a recent clinical trial clearly demonstrated the superiority of doxycycline over azithromycin in the treatment of FBT in terms of time to fever clearance and the frequency of treatment failure [ 46 ]. In the current study, case patient #2 failed to improve while on azithromycin.…”

Section: Discussionmentioning

confidence: 99%

Flea-Borne Typhus as a COVID-19 Mimic: A Report of Four Cases

Dye,

Coba,

Dayton

et al. 2024

Case Reports in Infectious Diseases

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Flea-borne typhus (FBT), due to Rickettsia typhi and R. felis, is an infection causing fever, headache, rash, hepatitis, thrombocytopenia, and diverse organ manifestations. Cough occurs in about 30% of patients with FBT, and chest X-ray abnormalities are seen in 17%. Severe pulmonary manifestations have also been reported in FBT, including adult respiratory distress syndrome and pulmonary embolism. Because of these pulmonary manifestations, FBT can mimic Coronavirus Illness 2019 (COVID-19), a febrile illness with prominent respiratory involvement. Flea-borne typhus and COVID-19 may also have similar laboratory abnormalities, including elevated ferritin, C-reactive protein, and D-dimer. However, elevated transaminase levels, rash, and thrombocytopenia are more common in FBT. Herein, we present four cases of patients with FBT who were initially suspected to have COVID-19. These cases illustrate the problem of availability bias, in which the clinician thinks a particular common condition (COVID-19 in this case) is more prevalent than it actually is.

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“…The use of doxycycline for rickettsioses in young children is endorsed by the American Academy of Pediatrics Committee on Infectious Diseases [159]. Most pregnant women with murine typhus have favorable outcomes, but poor neonatal outcomes from those with suboptimal treatment have been reported [163,164]. Doxycycline does not seem to be associated with the severe adverse events in pregnant women that have been reported with older tetracyclines [165,166].…”

Section: Treatment and Preventionmentioning

confidence: 99%

Murine Typhus: A Review of a Reemerging Flea-Borne Rickettsiosis with Potential for Neurologic Manifestations and Sequalae

Blanton

2023

Infectious Disease Reports

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Murine typhus is an acute febrile illness caused by Rickettsia typhi, an obligately intracellular Gram-negative coccobacillus. Rats (Rattus species) and their fleas (Xenopsylla cheopis) serve as the reservoir and vector of R. typhi, respectively. Humans become infected when R. typhi-infected flea feces are rubbed into flea bite wounds or onto mucous membranes. The disease is endemic throughout much of the world, especially in tropical and subtropical seaboard regions where rats are common. Murine typhus is reemerging as an important cause of febrile illness in Texas and Southern California, where an alternate transmission cycle likely involves opossums (Didelphis virginiana) and cat fleas (Ctenocephalides felis). Although primarily an undifferentiated febrile illness, a range of neurologic manifestations may occur, especially when treatment is delayed. Serology is the mainstay of diagnostic testing, but confirmation usually requires demonstrating seroconversion or a fourfold increase in antibody titer from acute- and convalescent-phase sera (antibodies are seldom detectable in the first week of illness). Thus, early empiric treatment with doxycycline, the drug of choice, is imperative. The purpose of this review is to highlight murine typhus as an important emerging and reemerging infectious disease, review its neurologic manifestations, and discuss areas in need of further study.

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Murine Typhus Infection in Pregnancy: Case Series and Literature Review

Cited by 6 publications

References 33 publications

Foetal outcome of Leptospira and Rickettsial infections during pregnancy: A Systematic Review

Foetal outcome of Leptospira and Rickettsial infections during pregnancy: A Systematic Review

Flea-Borne Typhus as a COVID-19 Mimic: A Report of Four Cases

Murine Typhus: A Review of a Reemerging Flea-Borne Rickettsiosis with Potential for Neurologic Manifestations and Sequalae

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