Diagnosis and treatment of murine typhus
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
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".)
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 .
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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