Murine typhus is one of the most prevalent rickettsial infections in the world, caused by the bacterial genus Rickettsia. Though the disease manifests a relatively benign clinical course with fever, rash, and headache being the 3 classic symptoms, neurological complications may arise in patients that could become permanent. In this case study, a patient with a brain abscess caused by R typhi infection is described. Based upon the recent reemergence of arthropod-borne disease, the findings in this case are significant; R typhi can cause a brain abscess that mimics a brain tumor, which delays the diagnosis and appropriate management of the disease. Murine typhus should always be considered when performing the differential diagnosis of brain abscesses in South Korea.
Brain Abscess* ; Brain Neoplasms* ; Brain* ; Diagnosis ; Diagnosis, Differential ; Exanthema ; Fever ; Headache ; Humans ; Korea ; Rickettsia* ; Typhus, Endemic Flea-Borne

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

OBJECTIVETo analyze clinical manifestations, treatment and prognosis of 4 cases with endemic typhus.

METHODThe clinical data of four endemic typhus patients in prognosis were retrospectively analyzed. These four atypical cases of endemic typhus with pneumonia were treated in our department from October 2011 to March 2012. They were all male, with an age range of 15 months to 7 years. The four patients had long history, mild respiratory symptom and no improvement was found after treatment with cephalosporins. There were no evidences of bacterial, viral, or fungal infections and we thought they might have infection with other pathogen. Three were from rural areas. Routine blood tests, Weil-Felix reaction, blood smear (Giemsa staining) , and indirect immunofluorescence assay were performed.

RESULTBlood smear and IFA tests showed evidences for endemic typhus. The clinical presentations were atypical, the patients had no headache, but all had fever, rash, and pneumonia of varying severity. None of the patients had a severe cough, but bronchial casts were observed in one case. Recurrent fever was reported in three cases. Physical examinations showed no eschars, but one patient had a subconjunctival hemorrhage, and one had skin scratches, cervical lymphadenopathy, pleural effusion, pericardial effusion, and cardiac dilatation. Two patients had remarkably increased peripheral blood leukocyte counts; both these patients also had high alanine aminotransferase (ALT) levels and one had a high C-reactive protein (CRP) level. Weil-Felix testing was negative or the OX19 titer was low. The peripheral blood smear (Giemsa stain) showed intracellular pathogens in all four cases. After combined therapy with doxycycline and macrolide antibiotics, all four patients recovered well.

CONCLUSIONThe endemic typhus children often come from rural areas. The clinical presentations were atypical, they usually have no headache, but have fever (often Periodic fever) , rash, and pneumonia of varying severity in these four cases. Combined therapy with doxycycline and macrolide antibiotics was effective in all four patients.

Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; Doxycycline ; therapeutic use ; Fever ; diagnosis ; drug therapy ; pathology ; Fluorescent Antibody Technique, Indirect ; Humans ; Infant ; Leukocyte Count ; Lung ; diagnostic imaging ; pathology ; Macrolides ; therapeutic use ; Male ; Pneumonia ; diagnosis ; drug therapy ; pathology ; Radiography ; Retrospective Studies ; Staining and Labeling ; methods ; Typhus, Endemic Flea-Borne ; diagnosis ; drug therapy ; pathology

OBJECTIVETo identify epidemic status of murine typhus in Hongta areas of Yuxi city and to provide evidence for control and prevention of the disease.

METHODSSerologic survey was conducted among residents and rodents. Isolation of Rickettsia moseri was performed.

RESULTSThe overall infection rate among general population was 28.92% (96/332) with geometric meantiter (GMT) as 10.83 and there was no difference between males and females (26.71%, 43/161 vs. 30.99%, 53/171, P > 0.05). Significant differences were found between age groups (P < 0.05) with positive rates of 29.63% (8/27), 18.06% (13/72), 39.62% (42/106), 27.50% (22/80) and 23.40% (11/47) among age groups 0-6, 7-18, 19-39, 40-59 and over 60, respectively. The overall rate of infection in mouse was 44.95% (89/198) with GMT as 30.30. Five isolates of R. moseri from mouse specimen, three from fleas plus one case of murine typhus were diagnosed. Rattus norvegicus and Rattus flavipectus were the predominant species of rodent animals (99.49%, 197/198) and Xenopsylla cheopis was the major species of vector (74.26%, 303/408). Flea index and mouse density were 2.06 and 11.13% respectively.

CONCLUSIONHigh infection rates on R. moseri were demonstrated in rodents and residents as well as high risk of murine typhus outbreak might occur in these areas.

Adolescent ; Adult ; Animals ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Mice ; Middle Aged ; Rats ; Rodent Diseases ; epidemiology ; microbiology ; transmission ; Siphonaptera ; microbiology ; Typhus, Endemic Flea-Borne ; epidemiology ; microbiology ; transmission ; Young Adult

A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus.
Aneurysm, False ; Humans ; Infarction ; Rupture ; Scrub Typhus ; Spleen ; Splenic Rupture ; Typhus, Endemic Flea-Borne

BACKGROUNDHuman rickettsioses are worldwide zoonoses and it is not easy to differentiate them from other infectious diseases because of their atypical manifestation. In recent years the number of patients with fever of unknown causes from Hongta District CDC, Yuxi city of Yunnan Province has been increasing significantly in the summer. Diagnosis of scrub typhus was made by local clinicians. In order to ascertain the disease, we undertook a laboratory investigation for such patients from August 18 to 26, 2005.

METHODSActive surveillance was conducted by Hongta District CDC Yuxi city of Yunnan Province from 2002 to 2004 and basic data were obtained from cases confirmed according to clinical definitions. Average incidences and town-level incidences were calculated during the study periods. Blood samples were analyzed by PCR and serological test. Based on the groEL gene sequences a paired general outer primers (Gro-1 and Gro-2) targeting typhus, spotted fever as well as scrub typhus and two paired inner primers (SF1, SR2 and TF1, TR2) for typhus together with spotted fever and scrub typhus, respectively, were designed to perform a multiplex-nested PCR. Serological assay was carried out by indirect immunofluorescence assay with 7 different rickettsial antigens, i.e., R.mossori, R.sibirica, R.conorii, O.tsutsugamushi, B.quintana, B.henselae and Coxilella burnetii phase II Ag.

RESULTSEpidemiological surveillance showed that from 2002 to 2004, the average incidences of the scrub typhus or scrub typhus with murine typhus were 222.1/10(5), 204.3/10(5) and 109.6/10(5), respectively. Of 13 blood samples taken during acute stage of illness, 6 showed the amplified products for scrub typhus and the sequenced products showed 100%, 99%, 99%, 99%, 99%, 99% similarity to O.tsutsugamushi Karp but they shared the same deduced amino acid sequences, which indicated 100% identity with the heat shock protein of the O.tsutsugamushi Karp strain. Five yielded PCR products for murine typhus and their corresponding nucleotide sequences exhibited 100%, 100%, 99%, 99% and 99% similarity to R. mossori Wilmington and the analyses of predicted amino acid sequences indicated 100%, 100%, 98%, 98% and 98% identity with the heat shock protein of R. mossori Wilmington strain. Of the 8 PCR positive patients, 3 showed a co-infection of scrub typhus with murine typhus. All the 13 serum samples from febrile patients were positive against O. tsutsugamushi and 8 of them were positive against R. mossori. All of the 8 paired specimens had four-fold elevation of antibody against O. tsutsugamushi, and seroconversion for typhus was demonstrated in 3 paired serum samples. Another finding in the study was that a high seropositive prevalence (76.9%) of Q fever was detected.

CONCLUSIONIt's confirmed that co-prevalence of scrub typhus with murine typhus are occurring in Yuxi city of Yunnan province, China. Other rickettsial diseases also need to be investigated in these areas.

Adolescent ; Adult ; Aged ; Antibodies, Bacterial ; blood ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Orientia tsutsugamushi ; genetics ; immunology ; Polymerase Chain Reaction ; Prevalence ; Scrub Typhus ; diagnosis ; epidemiology ; Typhus, Endemic Flea-Borne ; diagnosis ; epidemiology

BACKGROUND: Spotted fever group rickettsiosis occurs worldwide and includes various causative organisms depending on the region and clinical features. In Korea, previous studies have shown that several kinds of spotted fever rickettsiae have been identified in ticks, and in stored sera obtained from febrile patients. Previously, it was difficult to correlate the results of serologic or molecular biologic tests with the clinical or epidemiological features of this disease in humans. In 2004, the first Korean patient with Japanese spotted fever (JSF) was identified on Mueui Island, Incheon, Korea. To estimate the prevalence of JSF and to compare the incidence of JSF with those of other infectious diseases endemic to Korea, we performed a serosurvey of Japanese spotted fever and other rickettsiosis (scrub typhus and murine typhus), hemorrhagic fever with renal syndrome and leptospirosis on the island where the patient had been living. MATERIALS AND METHODS: In October 2004, we performed a seroprevalence survey of Mueui Island where nearly 300 persons resided. There were 91 persons who participated in the survey and answered the questionnaire. The participants included 30 healthy subjects receiving a check up at the Health Promotion Center at Inha University Hospital, and 30 patients with rheumatoid factor as control groups for the serologic tests. RESULTS: Of the 91 residents, only one person showed a positive reaction to R. japonica at a titer of 1:80. IgG antibodies against O. tsutsugamushi were positive at a titer of 1:32 in 3 persons, and those against R. typhi were at 1:32 in 1 person and at 1:64 in 2 persons. Serum IgG antibodies to Hantan virus were positive at a dilution of 1:64 in 2 persons and those to leptospira were negative. All 30 healthy persons and 30 patients with rheumatoid factor in the control group showed negative results in 1:40 diluted sera. CONCLUSION: This study demonstrates that the seroprevalence of R. japonica is not as high in Korea as it is in Japan. Further studies should be performed in a large number of patients, including residents of other islands and the Korean peninsula.
Antibodies ; Asian Continental Ancestry Group* ; Communicable Diseases ; Fever* ; Health Promotion ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Immunoglobulin G ; Incheon ; Incidence ; Islands ; Japan ; Korea ; Leptospira ; Leptospirosis ; Prevalence ; Rheumatoid Factor ; Rickettsia* ; Scrub Typhus ; Seroepidemiologic Studies* ; Serologic Tests ; Ticks ; Typhus, Endemic Flea-Borne ; Typhus, Epidemic Louse-Borne ; Surveys and Questionnaires

BACKGROUND: Spotted fever group rickettsiosis occurs worldwide and includes various causative organisms depending on the region and clinical features. In Korea, previous studies have shown that several kinds of spotted fever rickettsiae have been identified in ticks, and in stored sera obtained from febrile patients. Previously, it was difficult to correlate the results of serologic or molecular biologic tests with the clinical or epidemiological features of this disease in humans. In 2004, the first Korean patient with Japanese spotted fever (JSF) was identified on Mueui Island, Incheon, Korea. To estimate the prevalence of JSF and to compare the incidence of JSF with those of other infectious diseases endemic to Korea, we performed a serosurvey of Japanese spotted fever and other rickettsiosis (scrub typhus and murine typhus), hemorrhagic fever with renal syndrome and leptospirosis on the island where the patient had been living. MATERIALS AND METHODS: In October 2004, we performed a seroprevalence survey of Mueui Island where nearly 300 persons resided. There were 91 persons who participated in the survey and answered the questionnaire. The participants included 30 healthy subjects receiving a check up at the Health Promotion Center at Inha University Hospital, and 30 patients with rheumatoid factor as control groups for the serologic tests. RESULTS: Of the 91 residents, only one person showed a positive reaction to R. japonica at a titer of 1:80. IgG antibodies against O. tsutsugamushi were positive at a titer of 1:32 in 3 persons, and those against R. typhi were at 1:32 in 1 person and at 1:64 in 2 persons. Serum IgG antibodies to Hantan virus were positive at a dilution of 1:64 in 2 persons and those to leptospira were negative. All 30 healthy persons and 30 patients with rheumatoid factor in the control group showed negative results in 1:40 diluted sera. CONCLUSION: This study demonstrates that the seroprevalence of R. japonica is not as high in Korea as it is in Japan. Further studies should be performed in a large number of patients, including residents of other islands and the Korean peninsula.
Antibodies ; Asian Continental Ancestry Group* ; Communicable Diseases ; Fever* ; Health Promotion ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Immunoglobulin G ; Incheon ; Incidence ; Islands ; Japan ; Korea ; Leptospira ; Leptospirosis ; Prevalence ; Rheumatoid Factor ; Rickettsia* ; Scrub Typhus ; Seroepidemiologic Studies* ; Serologic Tests ; Ticks ; Typhus, Endemic Flea-Borne ; Typhus, Epidemic Louse-Borne ; Surveys and Questionnaires

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

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