Volume 98 Number 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Murine typhus, caused by , is an undifferentiated febrile illness with no available rapid and sensitive diagnostic assay for use during early disease. We aimed to compare the health-care charges in those diagnosed with murine typhus to those with influenza, a febrile illness with an available rapid diagnostic test. A comparison of health-care–associated charges at the University of Texas Medical Branch at Galveston demonstrated a median of $817 for influenza versus $16,760 for murine typhus ( < 0.0001). Median laboratory ($184 versus $3,254 [ < 0.0001]) and imaging charges ($0 versus $514 [ < 0.0001]) were also higher in those with murine typhus. Those receiving at least one imaging study during their illness were greater in the murine typhus group (91.3% versus 20.3%) ( < 0.0001). The median time needed to establish a confirmed or presumptive diagnosis was 2 days for influenza compared with 9 days for murine typhus ( < 0.0001). The median number of health-care encounters was greater for those with murine typhus (2 versus 1) ( < 0.0001). Eleven patients (15.9%) with influenza were hospitalized as a result of their illness compared with 16 (69.6%) with murine typhus ( < 0.0001). The estimated mortality based on disease severity at presentation by Acute Physiology and Chronic Health Evaluation II scoring was similar in the two groups—both had a median 4% mortality risk ( = 0.0893). These results highlight the need for improved clinical recognition and diagnostics for acute rickettsioses such as murine typhus.


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  • Received : 26 May 2017
  • Accepted : 24 Feb 2018

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