Murine typhus is a flea-borne infectious disease caused by Rickettsia typhi, of which myocarditis is a rare complication in the acute disseminating phase. A 62-year-old female presented with a fever and was diagnosed with murine typhus. She was treated with doxycycline and discharged after complete resolution of the fever. However, recurrent presyncope and exertional dyspnea developed 6-8 weeks later. Complete atrioventricular (AV) block with a wide QRS escape rhythm and a left bundle branch block configuration was documented. Subacute myocarditis was diagnosed based on persistent cardiac troponin-I elevation and typical cardiac magnetic resonance imaging findings. A permanent pacemaker was implanted for symptomatic complete AV block. Few reports of myocarditis in murine typhus have been published. We report a case of murine typhus myocarditis complicated by complete AV block in the late convalescence phase.
Atrioventricular Block ; Bundle-Branch Block ; Communicable Diseases ; Convalescence ; Doxycycline ; Dyspnea ; Female ; Fever ; Humans ; Magnetic Resonance Imaging ; Myocarditis ; Rickettsia typhi ; Syncope ; Troponin I ; Typhus, Endemic Flea-Borne ; United Nations

Murine typhus is an infectious disease caused by Rickettsia typhi, an intracellular parasite that lives in the cytoplasm of host cells. Rickettsia typhi infection can induce lymphohistiocytic vasculitis leading to pulmonary, cardiovascular, central nervous system and renal complications. We experienced a case of acute renal failure resulting from acute tubulointerstitial nephritis associated with murine typhus infection. A 67 year old man was transferred from local hospital due to fever, confusion, oliguria with renal failure. Laboratory finding showed elevated liver enzyme with hypoalbuminemia and progressive azotemia. Despite supportive care, his azotemia progressed with anuria and acute hemodialysis was started. Kidney biopsy showed acute tubulointerstitial nephritis with vasculitis and indirect immunofluorecent antibody to murine typhus was 1: 3, 200. Doxycyclin was started and his renal function recovered. We report a case of acute renal failure resulting from murine typhus infection induced acute tubulointerstitial nephritis.
Acute Kidney Injury* ; Aged ; Anuria ; Azotemia ; Biopsy ; Central Nervous System ; Communicable Diseases ; Cytoplasm ; Fever ; Humans ; Hypoalbuminemia ; Kidney ; Liver ; Nephritis, Interstitial* ; Oliguria ; Parasites ; Renal Dialysis ; Renal Insufficiency ; Rickettsia typhi ; Typhus, Endemic Flea-Borne* ; Vasculitis

Coxiella burnetii is the etiological agent of Q fever, that may occur either acutely or the chronically. To understand the seroepidemiological patterns of C. burnetii infection in Korea, we examined a total of 3,178 sera from patients with acute febrile episodes by using indirect immunofluorescence assay (IFA) for detectable antibodies to C. burnetii and other eight rickettsial antigens. The IFA seropositivity>or=1:20 for C. burnetii phase II was 11.5% (368 out of 3,178 sera). The co-existence of antibodies to other rickettsial antigens was found in 216 out of the 368 positive sera. Thirty-seven point five percent (n=138) had antibodies to R. tsutsugamushi (cutoff>or=1:20), 16% (n=59) to Ehrlichia sennetsu, 14.9% (n=55) to Rickettsia typhi, 13.5% (n=50) to R. akari, 11.4% (n=42) to R. japonica, 8.9% (n=33) to R. prowazekii, 7.6% (n=28) to R. sibirica, and 6.7% (n=25) to R. conorii by IFA, respectively. These results are consistent with previous reports documenting diverse serum cross-reactivity in chronic Q fever. Therefore we excluded the samples that reacted to other rickettsial antigens at same or higher titers than to C. burnetii, resulting in the seropositive rate of 4.1%. The serological prevalence was 2% (n=64) when the conventional cut-off titer of 1:80 was used. Our results suggest that infections with C. burnetii are more prevalent than expected previously and should be differentially diagnosised for febrile illness occurring after exposure to ticks or other vectors.
Antibodies ; Coxiella burnetii* ; Coxiella* ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Humans ; Korea ; Neorickettsia sennetsu ; Prevalence ; Q Fever ; Rickettsia ; Rickettsia typhi ; Seroepidemiologic Studies* ; Ticks

BACKGROUND: Murine typhus is a fea-borne, worldwide Rickettsial disease caused by Rickettsia typhi. Its symptoms are typically mild byt sometimes can be fatal. The major clinical features include fever, rash, and headache. Recently, we experienced 6 cases of ARDS associated with a Rickettsia typhi infection. This study was aimed to analyze the attributing factors for fatal murine typhus and to review the characteristics of the pateints who showed acute respiratory distress syndrome as the initial presentation. METHODS: The medical records of 15 patients diagnosed as murine typhus were reviewed. The diagnosis was made by single titers of 1:512 or higher, or a 4-fold rise with compatible clinical features. Acute Respiratory Distress syndrome (ARDS) was define according to the American-European Consensus Conference. The characteristics between the ARDS group and the non-ARDS group of murine typhus were compared. RESULTS: Six patients developed ARDS as their initial presentation. Two of them were women and three of them had lived urban area. None of them a showed skin rash. One of them expired during treatment. The time lapse until the commencement of the specific treatment, the lower serum albumin level, the higher serum total bilirubin level, the higher APACHE III score and the higher MOD score were significantly associated with the ARDS group compared to the non-ARDS group. CONCLUSIONS: Murine typhus should be considered as one of the etiologies for the ARDS of unknown cause, particularly in an endemic regions. ARDS caused by Murine typhus generally has a good prognosis.
APACHE ; Bilirubin ; Consensus ; Diagnosis ; Exanthema ; Female ; Fever ; Headache ; Humans ; Medical Records ; Prognosis ; Respiratory Distress Syndrome, Adult* ; Rickettsia typhi ; Serum Albumin ; Typhus, Endemic Flea-Borne*

Murine typhus is an acute febrile illness caused by Rickettsia typhi. It is one of the four major acute febrile illnesses in Korea during autumn. To study a species-specific antigen of R. typhi, two clinical isolates (87-91 and 87-100) and two reference strains (VR-144 and VR-738) were analyzed by mouse antisera and monoclonal antibodies (MAbs). On SDS- polyacrylamide gel electrophoresis (PAGE), R. typhi showed major antigen bands of 135, 80, 75, 64, 47, 22, and 19 kDa and these bands differed with those of other species. On Western blot analysis, the MAbs reacting only with R. typhi could only detect 135 kDa protein. The 135 kDa protein appeared to be the species-specific antigen. Other MAbs showing cross-reactivity with R. prowazekii reacted with 135 kDa protein in fresh culture supernatant of R. typhi infected host cell. However, the cross-reacting antibody did also react with smaller protein bands, most of which seem to be degradation products of the 135 kDa protein since they increase in old protein stocks purified from R. typhi harvested from infected host cell. These suggest that 135 kDa protein is unstable and the R. typhi specific epitopes are located at the regions of 135 kDa protein that are removed when the protein is degraded. The 135 kDa protein or its specific and stable recombinant protein would serve an important target for the development of vaccine and specific diagnostic antigen.
Animals ; Antibodies, Monoclonal ; Blotting, Western ; Electrophoresis, Polyacrylamide Gel ; Epitopes ; Immune Sera ; Korea ; Mice ; Rickettsia typhi* ; Rickettsia* ; Typhus, Endemic Flea-Borne

Murine (endemic) typhus is a zoonotic infection caused by Rickettsia typhi (formerly known as Rickettsia mooseri). Rickettsia typhi is an obligate intracellular organism that multiplies within the cytoplasm of mainly endothelial cells. It is transmitted from rats by injection of contaminated flea feces into the skin of the host. The disease manifests itself with the gradual onset of fever, myalgia, and headache appearing 7-14 days after infection. A maculopapular rash is found in some patients (proportions ranging from 20 to 80% in different series). We report a rare case of murine typhus with presentation of hemorrhagic vesicles and dyspnea which was treated at our emergency department, and we give a brief review of the literature.
Animals ; Cytoplasm ; Dyspnea* ; Emergency Service, Hospital ; Endothelial Cells ; Exanthema ; Feces ; Fever ; Headache ; Humans ; Myalgia ; Rats ; Rickettsia ; Rickettsia typhi ; Siphonaptera ; Skin ; Typhus, Endemic Flea-Borne* ; Typhus, Epidemic Louse-Borne ; Zoonoses

Hemorrhagic fever with renal syndrome (HFRS), scrub typhus, murine typhus and leptospirosis have been the principal acute febrile diseases in Korea for many years. To evaluate the seroepidemiologic patterns of the acute febrile illness, sera collected from 4,503 patients in 1997~1998 were examined for antibodies against Hantaan virus, Orientia tsutsugamushi and Rickettsia typhi by indirect immunofluorescent antibody technique (IFA) and macroscopic agglutination test for Leptospira interogans. Seropositive cases for Orientia tsutsugamushi, Rickettsia typhi, Leptospira interogans and Hantaan virus were 261 (12.4%), 242 (11.5%), 11 (0.5%), and 250 (11.9%) in 1997, and 415 (17.3%), 273 (11.4%), 16 (0.7%), and 357 (14.9%) in 1998, respectively. Male was affected more frequently by HFRS and leptospirosis while scrub typhus was more prevalent in female. Old age group was more susceptible to the acute febrile diseases. Most positive cases were occurred during October and November for scrub typhus, and during November and December for HFRS. These results showed similar patterns with previous epidemiological data obtained during recent several years, except the single scrub typhus epidemic in 1998, and implied that no significant changes occurred in ecologic system for acute febrile diseases in Korea.
Agglutination Tests ; Antibodies ; Ecosystem ; Female ; Hantaan virus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Korea* ; Leptospira ; Leptospirosis ; Male ; Orientia tsutsugamushi ; Rickettsia typhi ; Scrub Typhus ; Typhus, Endemic Flea-Borne

Rickettia typhi is an obligate intracellular organism and usually seen microscopically as gram-negative pleomorphic coccobacilli. Murine typhus is an acute febrile illness caused by R. typhi and transmitted to human by fleas. Fever, skin rash, headache, and myalgia characterize the clinical illness. The risk for laboratory personnel is from exposure to infectious aerosols, accidental inoculation, or exposure to bites by infected ectoparasites. A 27-year old man was admitted to the hospital because of fever and myalgia. He had worked with R. typhi in a laboratory and was exposed to R. typhi 10 days ago. The present illness began seven days before admission, when he developed high fever and conjunctival injection. One day before admission, he developed generalized erythematous skin rash and generalized edema. Immunofluorescence test with rickettsial antigen was positive at 1:4,096 on admission. He received 200 mg of doxycycline for 7 days and became afebrile on the third day after treatment.
Adult ; Aerosols ; Doxycycline ; Edema ; Exanthema ; Fever ; Fluorescent Antibody Technique ; Headache ; Humans ; Laboratory Personnel ; Myalgia ; Rickettsia typhi ; Siphonaptera ; Typhus, Endemic Flea-Borne*

Hemorrhagic fever with renal syndrome (HIFRS), scrub typhus, murine typhus and leptospirosis have been the principal acute febrile diseases in Korea. To evaluate the seroepidemiologic patterns of acute febrile illness, sera collected from 2,423 patients in 1996 were examined for antibodies against Hantaan virus, Orientia tsutsugamushi, Rickettsia typhi, and Borrelia burgdorferi by indirect immunofluorescent antibody technique (IFA) and macroscopic agglutination test for Leptospira interogans. Seropositive cases against O. tsutsugamushi, Rickettsia typhi, Leptispira interogans and Hantaan virus were 192 (7.9%), 193 (8.0%), 12 (0.5%) and 324 (13.4%), respectively. Male was more affected in HFRS and murine typhus contrasting to scrub typhus and leptospirosis in female. Most positive cases occurred during October and November for scrub typhus, and during November and December for HFRS. These results showed similar patterns with previous epidemical data for recent couple of years, and possibly implied no significant changes occurred in ecologic situations for acute febrile diseases in Korea.
Agglutination Tests ; Antibodies ; Borrelia burgdorferi ; Female ; Hantaan virus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Korea* ; Leptospira ; Leptospirosis ; Male ; Orientia tsutsugamushi ; Rickettsia typhi ; Scrub Typhus ; Typhus, Endemic Flea-Borne

BACKGROUND: The principal acute febrile diseases reported in autumn, Korea, have been hemorrhagic fever with renal syndrome (HFRS), scrub typhus, murine METHODS: To evaluate the seroepidemiologic patterns of acute febrile illness in Korea, sera were collected from 5330 patients from 1994 to 1995, and examined for antibodies against Hantaan virus, Orientia tsutsuga-mushi, Rickettsia typhi, and Borrelia burgdorf eri by indirect immunofluorescent antibody technique(IFA) and by macroscopic agglutination test for Leptosp ira intero-gans. RESULTS: Of 640 seropositive cases against O. tsutsu-gamushi, 60% were female; age group of the seventh decade occupied 30%; 89% were reported during October and November. By IFA test, the seropositive rate of murine typhus was 3.5% (187/5330) with high incidence rate (44%) in the period from October to December, and males in their forties and fifties were mostly affected. Cases seropositive for leptospirosis consisted 1% of 5330 acute febrile illness cases. Of 55 seropositive cases, 71% were male; 71% were in their sixties; 78% occurred during the period from August to October. Hantavirus seropositive rate was 12.2% (649/5330) with a high incidence rate (70%) in the period from October to January and males in the thirties were mostly infected. No seropositive case of Lyme disease was present. CONCLUSION: The above results indicate that hantavirus, O. tsutsugamushi, R. typhi, and L. interogans were the main causative agents of acute febrile diseases during autumn season in Korea.
Agglutination Tests ; Antibodies ; Borrelia ; Female ; Hantaan virus ; Hantavirus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Incidence ; Korea* ; Leptospirosis ; Lyme Disease ; Male ; Rickettsia typhi ; Scrub Typhus ; Seasons ; Typhus, Endemic Flea-Borne