Sunbathing, a possible risk factor of murine typhus infection in Greece

Abstract

Background There are few studies about the presence of murine typhus in Greece. Our objective was to conduct a large scale retrospective investigation to determine the clinical and epidemiological features of patients diagnosed with murine typhus in Greece. Methodology/Principal findings From 2012 to 2019 serum samples from hospitalized patients and outpatients throughout Greece suspected for murine typhus infection were tested by immunofluorescence assay for Rickettsia typhi. Immunofluorescence positive samples obtained since 2016 were also tested by qPCR targeting R. typhi. Clinical and epidemiological data were retrospectively collected for the patients with confirmed murine typhus. Overall, we tested 5,365 different patients and, in total, 174 patients from all geographic regions of Greece were diagnosed with murine typhus. The most frequently reported sign or symptom was fever (89%), followed by headache (84%) and rash (81%). The classical triad of fever, headache, and rash was present in 72% of patients during their illness. Severe infections with complications including acute renal failure or septic shock were not recorded. The majority of cases (81%) occurred during May–October and peaked in June and September. Most of patients (81%) infected in Athens, recalled that their only activity the last weeks before symptoms onset was swimming on the beach and 59% of them also reported an insect bite while sunbathing. Conclusions/Significance Our results may reflect the reemergence of murine typhus in Greece and we highlight the importance of awareness of this difficult-to-recognize undifferentiated febrile illness.

Non-negligible seroprevalence of murine typhus and its predictors in Japan: a large-scale seroepidemiological study

“…MT is ubiquitous in developing countries, with seroprevalence rates of 6.5% and 5.4% in northern Vietnam (36) and southern India (18), respectively. In addition, the incidence of MT has temporarily decreased, but has become a problem in developed countries such as the US (California and Texas) (6–8), Greece (9), and Spain (10,11). One possible reason for the increase in MT in California and Texas is the improved disease recognition by clinicians through local epidemiological studies (8,37).…”

“…MT is distributed globally and is endemic in warm urban or coastal regions, where rats or cats, the reservoirs of R. typhi , tend to inhabit; however, epidemiological characteristics often differ from region to region (1). Reports from industrialized countries, such as the US (6–8), Greece (9), and Spain, (10,11) have accumulated. Epidemiological studies from the US have indicated that MT is endemic not in urban areas but in suburban areas (6,8), potentially due to a new transmission cycle between fleas and reservoirs, such as opossums (12,13).…”

Nonnegligible Seroprevalence and Predictors of Murine Typhus, Japan

“…A previous study in Spain showed a high incidence rate in patients who were much younger (mean age of ≈46 years) ( 3 ) than those reported in this study (mean age of 67 years). A study in Greece showed frequent epidemiologic links to flea exposure ( 4 ), but the study in Japan did not investigate this apparent risk factor. I do not believe that age-related differences in flea exposures exist in Japan; hence, it is likely that exposures might have occurred in the past, when persons in Japan had a lower standard of hygiene.…”

Expression of Concern: Sunbathing, a possible risk factor of murine typhus infection in Greece

“…This article [ 1 ] has been identified as one of a series of submissions for which we have concerns about the reported research ethics approval information and the article’s adherence to PLOS research ethics policies.…”