Volume 87, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Clinical information regarding murine typhus in Taiwan is limited. In this study, 81 cases of serologically documented murine typhus during 1992–2009 at four referral hospitals in southern Taiwan were analyzed. There was a significant correlation between average environmental temperature and case numbers of murine typhus (r = 0.747, = 0.005). Acute hepatitis was found in 67% of cases, and hyperbilirubinemia (serum total bilirubin ≥ 23.9 μmol/L) was found in 38%. The intervals between the initiation of appropriate therapy to defervescence were longer in patients with hyperbilirubinemia than those without hyperbilirubinemia (6.1 versus 4.1 days; = 0.015). Nine (11.1%) showed development of severe illnesses such as acute respiratory distress syndrome (2 patients), aseptic meningitis (3), and acute renal failure (4). Only one died of acute respiratory distress syndrome. Cases of murine typhus were often found during the summer and had acute febrile hepatitis. Those patients with hyperbilirubinemia tended to have a delayed recovery even with appropriate therapy.


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  1. Dumler JS, Taylor JP, Walker DH, , 1991. Clinical and laboratory features of murine typhus in south Texas, 1980 through 1987. JAMA 266: 13651370.[Crossref] [Google Scholar]
  2. Civen R, Ngo V, , 2008. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis 46: 913918.[Crossref] [Google Scholar]
  3. Silpapojakul K, Ukkachoke C, Krisanapan S, Silpapojakul K, , 1991. Rickettsial meningitis and encephalitis. Arch Intern Med 151: 17531757.[Crossref] [Google Scholar]
  4. Letaief AO, Kaabia N, Chakroun M, Khalifa M, Bouzouaia N, Jemni L, , 2005. Clinical and laboratory features of murine typhus in central Tunisia: a report of seven cases. Int J Infect Dis 9: 331334.[Crossref] [Google Scholar]
  5. Masalha R, Merkin-Zaborsky H, Matar M, Zirkin HJ, Wirguin I, Herishanu YO, , 1998. Murine typhus presenting as subacute meningoencephalitis. J Neurol 245: 665668.[Crossref] [Google Scholar]
  6. Vallejo-Maroto I, Garcia-Morillo S, Wittel MB, Stiefel P, Miranda M, Pamies E, Aparicio R, Carneado J, , 2002. Aseptic meningitis as a delayed neurologic complication of murine typhus. Clin Microbiol Infect 8: 826827.[Crossref] [Google Scholar]
  7. Galanakis E, Gikas A, Bitsori M, Sbyrakis S, , 2002. Rickettsia typhi infection presenting as subacute meningitis. J Child Neurol 17: 156157.[Crossref] [Google Scholar]
  8. Gikas A, Doukakis S, Pediaditis J, Kastanakis S, Psaroulaki A, Tselentis Y, , 2002. Murine typhus in Greece: epidemiological, clinical, and therapeutic data from 83 cases. Trans R Soc Trop Med Hyg 96: 250253.[Crossref] [Google Scholar]
  9. Silpapojakul K, Mitarnun W, Ovartlarnporn B, Chamroonkul N, Khow-Ean U, , 1996. Liver involvement in murine typhus. Q J Med 89: 623629.[Crossref] [Google Scholar]
  10. Syhavong B, Rasachack B, Smythe L, Rolain JM, Roque-Afonso AM, Jenjaroen K, Soukkhaserm V, Phongmany S, Phetsouvanh R, Soukkhaserm S, Thammavong T, Mayxay M, Blacksell SD, Barnes E, Parola P, Dussaix E, Raoult D, Humphreys I, Klenerman P, White NJ, Newton PN, , 2010. The infective causes of hepatitis and jaundice amongst hospitalized patients in Vientiane, Laos. Trans R Soc Trop Med Hyg 104: 475483.[Crossref] [Google Scholar]
  11. Hernandez Cabrera M, Angel-Moreno A, Santana E, Bolaños M, Francès A, Martín-Sánchez MS, Pérez-Arellano JL, , 2004. Murine typhus with renal involvement in Canary Islands, Spain. Emerg Infect Dis 10: 740743.[Crossref] [Google Scholar]
  12. Shaked Y, Shpilberg O, Samra Y, , 1994. Involvement of the kidneys in Mediterranean spotted fever and murine typhus. Q J Med 87: 103107. [Google Scholar]
  13. Weng TC, Yen TS, , 1961. Clinical observation on two weeks fever (murine typhus) in Taiwan. J Formos Med Assoc 60: 594602. [Google Scholar]
  14. Lee HC, Ko WC, Lee HL, Chen HY, , 2002. Clinical manifestations and complications of rickettsiosis in southern Taiwan. J Formos Med Assoc 101: 385392. [Google Scholar]
  15. Lai CH, Huang CK, Weng HC, Chung HC, Liang SH, Lin JN, Lin CW, Hsu CY, Lin HH, , 2008. Clinical characteristics of acute Q fever, scrub typhus, and murine typhus with delayed defervescence despite doxycycline treatment. Am J Trop Med Hyg 79: 441446. [Google Scholar]
  16. Tissot Dupont H, Raoult D, Brouqui P, Janbon F, Peyramond D, Weiller PJ, Chicheportiche C, Nezri M, Poirier R, , 1992. Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases. Am J Med 93: 427434.[Crossref] [Google Scholar]
  17. Singri N, Ahya SN, Levin ML, , 2003. Acute renal failure. JAMA 289: 747751.[Crossref] [Google Scholar]
  18. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R, , 1994. The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149: 818824.[Crossref] [Google Scholar]
  19. Notifiable Infectious Diseases Statistics System, Centers for Diseases Control, R.O.C. (Taiwan). Geographic Distribution of Indigenous Cases of Murine Typhus in Taiwan. Available at:http://nidss.cdc.gov.tw/NIDSS_DiseaseMap.aspx?dt=4&dc=2&disease=0820&d=3&i=0&s=determined_cnt&RK=M&Y1=2003&Y2=2012&MW1=01&MW2=12&Area=0&City=0&Town=0&Q=H. Accessed January 29, 2012. [Google Scholar]
  20. Whiteford SF, Taylor JP, Dumler JS, , 2001. Clinical, laboratory, and epidemiologic features of murine typhus in 97 Texas children. Arch Pediatr Adolesc Med 155: 396400.[Crossref] [Google Scholar]
  21. Silpapojakul K, Chupuppakarn S, Yuthasompob S, Varachit B, Chaipak D, Borkerd T, Silpapojakul K, , 1991. Scrub and murine typhus in children with obscure fever in the tropics. Pediatr Infect Dis J 10: 200203.[Crossref] [Google Scholar]
  22. Fergie JE, Purcell K, Wanat D, , 2000. Murine typhus in south Texas children. Pediatr Infect Dis J 19: 535538.[Crossref] [Google Scholar]
  23. Bitsori M, Galanakis E, Gikas A, Scoulica E, Sbyrakis S, , 2002. Rickettsia typhi infection in childhood. Acta Paediatr 91: 5961.[Crossref] [Google Scholar]
  24. Aronoff DM, Watt G, , 2003. Prevalence of relative bradycardia in Orientia tsutsugamushi infection. Am J Trop Med Hyg 68: 477479. [Google Scholar]
  25. Cunha BA, , 2006. The diagnostic significance of relative bradycardia in infectious diseases. Clin Microbiol Infect 6: 633634.[Crossref] [Google Scholar]
  26. Chang K, Lee NY, Chen YH, Lee HC, Lu PL, Chang CM, Wu CJ, Chen TC, Hsieh HC, Ko WC, , 2008. Acute Q fever in southern Taiwan: atypical manifestations of hyperbilirubinemia and prolonged fever. Diagn Microbiol Infect Dis 60: 211216.[Crossref] [Google Scholar]
  27. Lai CH, Huang CK, Chen YH, Chang LL, Weng HC, Lin JN, Chung HC, Liang SH, Lin HH, , 2009. Epidemiology of acute Q fever, scrub typhus, and murine typhus, and identification of their clinical characteristics compared to patients with acute febrile illness in southern Taiwan. J Formos Med Assoc 108: 367376.[Crossref] [Google Scholar]
  28. Liu LI, Lin KS, Lin KH, Chang HC, , 1991. The spectrum of beta-thalassemia mutations in Taiwan: identification of a novel frameshift mutation. Am J Hum Genet 48: 809812. [Google Scholar]
  29. Chiang SH, Wu KF, Liu TT, Wu SJ, Hsiao KJ, , 2003. Quality assurance program for neonatal screening of glucose-6-phosphate dehydrogenase. Southeast Asian J Trop Med Public Health 34: S130S134. [Google Scholar]
  30. Raoult D, Drancourt M, , 1991. Antimicrobial therapy of rickettsial diseases. Antimicrob Agents Chemother 35: 24572462.[Crossref] [Google Scholar]
  31. Phimda K, Hoontrakul S, Suttinont C, Chareonwat S, Losuwanaluk K, Chueasuwanchai S, Chierakul W, Suwancharoen D, Silpasakorn S, Saisongkorh W, Peacock SJ, Day NP, Suputtamongkol Y, , 2007. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother 51: 32593263.[Crossref] [Google Scholar]
  32. Strand O, Stromberg A, , 1990. Ciprofloxacin treatment of murine typhus. Scand J Infect Dis 22: 503504.[Crossref] [Google Scholar]
  33. Laferl H, Fournier PE, Seiberl G, Pichler H, Raoult D, , 2002. Murine typhus poorly responsive to ciprofloxacin: a case report. J Travel Med 9: 103104.[Crossref] [Google Scholar]
  34. Gikas A, Doukakis S, Pediaditis J, Kastanakis S, Manios A, Tselentis Y, , 2004. Comparison of the effectiveness of five different antibiotic regimens on infection with Rickettsia typhi: therapeutic data from 87 cases. Am J Trop Med Hyg 70: 576579. [Google Scholar]
  35. Walker DH, Parks FM, Betz TG, Taylor JP, Muehlberger JW, , 1989. Histopathology and immunohistologic demonstration of the distribution of Rickettsia typhi in fatal murine typhus. Am J Clin Pathol 91: 720724.[Crossref] [Google Scholar]
  36. Rosenthal T, Michaeli D, , 1977. Murine typhus and spotted fever in Israel in the seventies. Infection 5: 8284.[Crossref] [Google Scholar]
  37. Bernabeu-Wittel M, Pachon J, Alarcon A, López-Cortés LF, Viciana P, Jiménez-Mejías ME, Villanueva JL, Torronteras R, Caballero-Granado FJ, , 1999. Murine typhus as a common cause of fever of intermediate duration: a 17-year study in the south of Spain. Arch Intern Med 159: 872876.[Crossref] [Google Scholar]
  38. Whelton A, Donadio J, Elisberg BL, , 1968. Acute renal failure complicating rickettsial infections in glucose-6-phosphate dehydrogenase-deficient individuals. Ann Intern Med 69: 323328.[Crossref] [Google Scholar]
  39. Bernabeu-Wittel M, Villanueva-Marcos JL, de Alarcon-Gonzalez A, Pachon J, , 1998. Septic shock and multiorganic failure in murine typhus. Eur J Clin Microbiol Infect Dis 17: 131132.[Crossref] [Google Scholar]

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  • Received : 18 Jul 2011
  • Accepted : 12 Apr 2012
  • Published online : 02 Jul 2012

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