- The American Society of Tropical Medicine and Hygiene,
oa Fatal Flea-Borne Typhus in Texas: A Retrospective Case Series, 1985–2015
Flea‐borne (murine) typhus is a global rickettsiosis caused by Rickettsia typhi. Although flea‐borne typhus is no longer nationally notifiable, cases are reported for surveillance purposes in a few U.S. states. The infection is typically self‐limiting, but may be severe or life threatening in some patients. We performed a retrospective review of confirmed or probable cases of fatal flea‐borne typhus reported to the Texas Department of State Health Services during 1985–2015. When available, medical charts were also examined. Eleven cases of fatal flea‐borne typhus were identified. The median patient age was 62 years (range, 36–84 years) and 8 (73%) were male. Patients presented most commonly with fever (100%), nausea and vomiting (55%), and rash (55%). Respiratory (55%) and neurologic (45%) manifestations were also identified frequently. Laboratory abnormalities included thrombocytopenia (82%) and elevated hepatic transaminases (63%). Flea or animal contact before illness onset was frequently reported (55%). The median time from hospitalization to administration of a tetracycline‐class drug was 4 days (range, 0–5 days). The median time from symptom onset to death was 14 days (range, 1–34 days). Flea‐borne typhus can be a life‐threatening disease if not treated in a timely manner with appropriate tetracycline‐class antibiotics. Flea‐borne typhus should be considered in febrile patients with animal or flea exposure and respiratory or neurologic symptoms of unknown etiology.
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