The epidemiology and clinical manifestations 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 actual incidence of murine typhus is difficult to establish since infection can be mild and self-limited, and clinically similar to other causes of rash and fever.
This topic will review the epidemiology and clinical manifestation of murine typhus. A discussion on diagnosis and treatment is found elsewhere. (See "Diagnosis and treatment of murine typhus".)
Rickettsia typhi is a member of the typhus group of rickettsiae that also includes the agent of epidemic typhus, R. prowazekii. These organisms are obligate intracellular, gram-negative bacteria that can only be grown in tissue culture, the cells of experimental animals, or chick embryos. (See "Biology of Rickettsia rickettsii infection".)
Murine typhus is primarily transmitted by the rat flea, Xenopsylla cheopis. Additional vectors include the cat flea, Ctenocephalides felis, and the mouse flea, Leptopsyllia segnis. Fleas remain permanently infected with Rickettsia typhi, and their lifespan is not shortened by the presence of rickettsiae. Humans are infected by inoculation of infective flea feces in bite wounds .
The majority of cases of murine typhus are associated with sites in which rats accumulate in large numbers. However, in suburban locations in the United States, domestic cats, cat fleas, and opossums may maintain a cycle of both R. typhi and Rickettsia felis (a spotted fever group rickettsia that is flea-borne and produces an illness that is clinically indistinguishable from murine typhus) . House mice, cats, and shrews occasionally serve as hosts to infected fleas. In addition, domestic cats may have serologic evidence of infection with R. typhi in both endemic and nonendemic regions. In one study, cats were also shown to have detectable R. typhi DNA in their blood using molecular methods . (See "Other spotted fever group rickettsial infections".)
- Civen R, Ngo V. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis 2008; 46:913.
- Nogueras MM, Pons I, Ortuño A, et al. Molecular detection of Rickettsia typhi in cats and fleas. PLoS One 2013; 8:e71386.
- Purcell K, Fergie J, Richman K, Rocha L. Murine typhus in children, South Texas. Emerg Infect Dis 2007; 13:926.
- Azad AF. Epidemiology of murine typhus. Annu Rev Entomol 1990; 35:553.
- Centers for Disease Control and Prevention (CDC). Outbreak of Rickettsia typhi infection - Austin, Texas, 2008. MMWR Morb Mortal Wkly Rep 2009; 58:1267.
- Walker DH, Parks FM, Betz TG, et al. Histopathology and immunohistologic demonstration of the distribution of Rickettsia typhi in fatal murine typhus. Am J Clin Pathol 1989; 91:720.
- Tsioutis C, Zafeiri M, Avramopoulos A, et al. Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review. Acta Trop 2017; 166:16.
- Whiteford SF, Taylor JP, Dumler JS. Clinical, laboratory, and epidemiologic features of murine typhus in 97 Texas children. Arch Pediatr Adolesc Med 2001; 155:396.
- Silpapojakul K, Chayakul P, Krisanapan S, Silpapojakul K. Murine typhus in Thailand: clinical features, diagnosis and treatment. Q J Med 1993; 86:43.
- Dumler JS, Taylor JP, Walker DH. Clinical and laboratory features of murine typhus in south Texas, 1980 through 1987. JAMA 1991; 266:1365.
- Stuart, BM, Pullen, RL. Endemic (murine) typhus. Clinical observations of 180 cases. Ann Intern Med 1945; 23:520.
- Vander T, Medvedovsky M, Valdman S, Herishanu Y. Facial paralysis and meningitis caused by Rickettsia typhi infection. Scand J Infect Dis 2003; 35:886.
- Shaked Y, Shpilberg O, Samra Y. Involvement of the kidneys in Mediterranean spotted fever and murine typhus. Q J Med 1994; 87:103.
- Khairallah M, Ben Yahia S, Toumi A, et al. Ocular manifestations associated with murine typhus. Br J Ophthalmol 2009; 93:938.
- Fergie J, Purcell K. Spontaneous splenic rupture in a child with murine typhus. Pediatr Infect Dis J 2004; 23:1171.
- McKelvey SD, Braidly PC, Stansby GP, Weir WR. Spontaneous splenic rupture associated with murine typhus. J Infect 1991; 22:296.
- Whelton A, Donadio JV Jr, Elisberg BL. Acute renal failure complicating rickettsial infections in glucose-6-phosphate dehydrogenase-deficient individuals. Ann Intern Med 1968; 69:323.
- Walker DH. The role of host factors in the severity of spotted fever and typhus rickettsioses. Ann N Y Acad Sci 1990; 590:10.
- Walker DH. Rocky Mountain spotted fever: a seasonal alert. Clin Infect Dis 1995; 20:1111.
- Masalha R, Merkin-Zaborsky H, Matar M, et al. Murine typhus presenting as subacute meningoencephalitis. J Neurol 1998; 245:665.