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Diagnosis and treatment of murine typhus

Author
Daniel J Sexton, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Murine (endemic) typhus is an uncommon flea-borne infectious disease caused by Rickettsia typhi. The illness is less commonly diagnosed in the United States than in the developing world because of improvements in hygiene and rat control efforts. The true incidence of this infection is difficult to establish because of the difficulty in distinguishing murine typhus from other causes of rash and fever.

This topic will review the diagnosis and treatment of murine typhus. A discussion on the epidemiology and clinical manifestations is found elsewhere. (See "The epidemiology and clinical manifestations of murine typhus".)

DIAGNOSIS

As with other rickettsial diseases, a reliable diagnostic laboratory test in the early phase of illness is not available. Thus, the diagnosis is usually based upon the typical clinical findings developing in an appropriate epidemiologic setting. The exposure history may not be helpful, since most patients do not remember a fleabite or contact with rodents [1].

The diagnosis is usually confirmed serologically after a course of empiric therapy with a tetracycline or chloramphenicol. Although rickettsial cultures of blood, skin biopsy with direct fluorescent antibody staining, and polymerase chain reaction have been used to diagnose murine typhus, the mainstay of diagnosis is the indirect fluorescent antibody test. This test is available through all state health department laboratories. A diagnosis of murine typhus can be established by a fourfold antibody titer rise between acute and convalescent serum samples.

However, it is important to note that R. typhi cross-reacts with Rickettsia prowazekii, the agent of epidemic typhus, and to a variety of spotted fever group antigens, including Rickettsia felis and Rickettsia rickettsii. Western blot testing and cross-adsorption studies can often help determine the infecting rickettsia in such cases. However, these techniques require specialized laboratories and such testing is expensive and time consuming [2,3].

      

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Literature review current through: Nov 2016. | This topic last updated: Wed Dec 09 00:00:00 GMT+00:00 2015.
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References
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  1. Silpapojakul K, Chayakul P, Krisanapan S, Silpapojakul K. Murine typhus in Thailand: clinical features, diagnosis and treatment. Q J Med 1993; 86:43.
  2. Purcell K, Fergie J, Richman K, Rocha L. Murine typhus in children, South Texas. Emerg Infect Dis 2007; 13:926.
  3. Mouffok N, Parola P, Raoult D. Murine typhus, Algeria. Emerg Infect Dis 2008; 14:676.
  4. Civen R, Ngo V. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis 2008; 46:913.
  5. Phongmany S, Rolain JM, Phetsouvanh R, et al. Rickettsial infections and fever, Vientiane, Laos. Emerg Infect Dis 2006; 12:256.
  6. Raby E, Dyer JR. Endemic (murine) typhus in returned travelers from Asia, a case series: clues to early diagnosis and comparison with dengue. Am J Trop Med Hyg 2013; 88:701.
  7. Chang K, Lee NY, Ko WC, et al. Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan. J Microbiol Immunol Infect 2014.
  8. Suputtamonghol, Y, Suttinont, C, Niwatayakul, K, et al. Epidemiology and clinical aspects of rickettsiosis in Thailand. Ann NY Acad Sci 2009; 1166:172.
  9. Phommasone K, Paris DH, Anantatat T, et al. Concurrent Infection with murine typhus and scrub typhus in southern Laos--the mixed and the unmixed. PLoS Negl Trop Dis 2013; 7:e2163.
  10. Fergie JE, Purcell K, Wanat D. Murine typhus in South Texas children. Pediatr Infect Dis J 2000; 19:535.
  11. Strand O, Strömberg A. Ciprofloxacin treatment of murine typhus. Scand J Infect Dis 1990; 22:503.
  12. Gikas A, Doukakis S, Pediaditis J, et al. Comparison of the effectiveness of five different antibiotic regimens on infection with Rickettsia typhi: therapeutic data from 87 cases. Am J Trop Med Hyg 2004; 70:576.
  13. Shaked Y, Samra Y, Maier MK, Rubinstein E. Relapse of rickettsial Mediterranean spotted fever and murine typhus after treatment with chloramphenicol. J Infect 1989; 18:35.