ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Civen R, Ngo V, 2008. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis 46: 913–918.
-
2.
Afzal Z, Kallumadanda S, Wang F, Hemmige V, Musher D, 2017. Acute febrile illness and complications due to murine typhus, Texas, USA. Emerg Infect Dis 23: 1268–1273.
-
3.
Murray KO, Evert N, Mayes B, Fonken E, Erickson T, Garcia MN, Sidwa T, 2017. Typhus group rickettsiosis, Texas, USA, 2003–2013. Emerg Infect Dis 23: 645–648.
-
4.
Adjemian J, Parks S, McElroy K, Campbell J, Eremeeva ME, Nicholson WL, McQuiston J, Taylor J, 2010. Murine typhus in Austin, Texas, USA, 2008. Emerg Infect Dis 16: 412–417.
-
5.
California Department of Public Health–Department of Public Health Vector-Borne Disease Section, 2018. Human Flea-Borne Typhus Cases in California. Available at: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH Document Library/Flea-borneTyphusCaseCounts.pdf. Accessed March 3, 2018.
-
6.
Eremeeva ME et al. 2012. Two pathogens and one disease: detection and identification of flea-borne rickettsiae in areas endemic for murine typhus in California. J Med Entomol 49: 1485–1494.
-
7.
Pieracci EG, Evert N, Drexler NA, Mayes B, Vilcins I, Huang P, Campbell J, Behravesh CB, Paddock CD, 2017. Fatal flea-borne typhus in Texas: a retrospective case series, 1985–2015. Am J Trop Med Hyg 96: 1088–1093.
-
8.
Dumler JS, Taylor JP, Walker DH, 1991. Clinical and laboratory features of murine typhus in south Texas, 1980 through 1987. JAMA 266: 365–1370.
-
9.
Chaliotis G, Kritsotakis EI, Psaroulaki A, Tselentis Y, Gikas A, 2012. International journal of infectious diseases murine typhus in central Greece: epidemiological, clinical, laboratory, and therapeutic-response features of 90 cases. Int J Infect Dis 16: 591–596.
-
10.
Tsioutis C, Zafeiri M, Avramopoulos A, Prousali E, Miligkos M, Karageorgos SA, 2017. Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: a systematic review. Acta Trop 166: 16–24.
-
11.
Theunissen C, Cnops L, Van Esbroeck M, Huits R, Bottieau E, 2017. Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report. BMC Infect Dis 17: 273.
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12.
Paris DH, Dumler JS, 2016. State of the art of diagnosis of rickettsial diseases: the use of blood specimens for diagnosis of scrub typhus, spotted fever group rickettsiosis, and murine typhus. Curr Opin Infect Dis 29: 433–439.
-
13.
Dumler JS, Walker DH, 1994. Diagnostic tests for Rocky Mountain spotted fever and other rickettsial diseases. Dermatol Clin 12: 25–36.
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14.
Blanton LS, 2013. Rickettsial infections in the tropics and in the traveler. Curr Opin Infect Dis 26: 435–440.
-
15.
Bernabeu-Wittel M, Villanueva-Marcos JL, de Alarcón-González A, Pachón J, 1998. Septic shock and multiorganic failure in murine typhus. Eur J Clin Microbiol Infect Dis 17: 131–132.
-
16.
Sakamoto N, Nakamura-Uchiyama F, Kobayashi KI, Takasaki T, Ogasawara Y, Ando S, Iwabuchi S, Ohnishi K, 2013. Severe murine typhus with shock and acute respiratory failure in a Japanese traveler after returning from Thailand. J Travel Med 20: 50–53.
-
17.
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: 720–724.
-
18.
Stephens BE, Thi M, Alkhateb R, Agarwal A, Sharkey FE, Dayton C, Anstead GM, 2018. Case report: fulminant murine typhus presenting with status epilepticus and multi-organ failure: an autopsy case and a review of the neurologic presentations of murine typhus. Am J Trop Med Hyg 99: 306–309.
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19.
Patel NJ, Caserta MP, DiSantis DJ, 2016. The “starry sky” liver. Ultrasound 14: 675–679.
-
20.
Chung JY, Hsu CC, Chen JH, Chen WL, Lin HJ, Guo HR, Huang CC, 2018. Geriatric influenza death (GID) score: a new tool for predicting mortality in older people with influenza in the emergency department. Sci Rep 8: 9312.
-
21.
Texas APR-DRG Grouper, 2018. Available at: https://rad.hhs.texas.gov/sites/rad/files/documents/hospital-svcs/2019/2019-hosp-aprdrg.pdf. Accessed August 14, 2018.
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22.
HHSC Hospital Rate Analysis Department, 2018. All Patient Refined Diagnosis Related Group. Available at: https://rad.hhs.texas.gov/sites/rad/files/documents/hospital-svcs/2018/2018-hosp-urban-sda.pdf. Accessed August 14, 2018.
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23.
Paoli CJ, Reynolds MA, Sinha M, Gitlin M, Crouser E, 2018. Epidemiology and costs of sepsis in the United States-an analysis based on timing of diagnosis and severity level. Crit Care Med 46: 1889–1897.
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24.
Vohra RF, Walker DH, Blanton LS, 2018. Analysis of health-care charges in murine typhus: need for improved clinical recognition and diagnostics for acute disease. Am J Trop Med Hyg 98: 1594–1598.
-
25.
Singer M et al. 2016. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315: 801–810.
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Seymour CW et al. 2016. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315: 762–774.
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Balasubramanian P, Sharma N, Biswal M, Bhalla A, Kumar S, Kumar V, 2018. Critical illness scoring systems: sequential organ failure assessment, acute physiology and chronic health evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions. Indian J Crit Care Med 22: 706–710.
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28.
Rhodes A et al. 2017. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock. Intensive Care Med 43: 304–377.
-
29.
Gou Y, Gao W, Yang H, Ma C, Sui S. 2016. De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: a meta-analysis. Heart Lung 45: 454–459.
-
30.
Newton PN et al. 2019. A prospective, open-label, randomized trial of doxycycline versus azithromycin for the treatment of uncomplicated murine typhus. Clin Infect Dis 68: 738–747.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 546 | 418 | 14 |
| Full Text Views | 768 | 16 | 0 |
| PDF Downloads | 192 | 20 | 0 |
Case Report: Early Doxycycline Therapy for Potential Rickettsiosis in Critically Ill Patients in Flea-Borne Typhus-Endemic Areas
Teresa A. Chueng
Teresa A. Chueng
Department of Medicine, Jackson Memorial Hospital, Miami, Florida;
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Kristopher R. Koch
Kristopher R. Koch
Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas;
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Gregory M. Anstead
Gregory M. Anstead
Division of Infectious Diseases, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas;
Medicine Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, San Antonio, Texas;
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Medicine Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, San Antonio, Texas;
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Apeksha N. Agarwal
Apeksha N. Agarwal
Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, Texas;
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Christopher L. Dayton
Christopher L. Dayton
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
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Flea-borne typhus (FBT), although usually perceived as a self-resolving febrile illness, actually encompasses a wide spectrum of disease severity, including fulminant sepsis with multi-organ failure. In endemic Texas and California, the incidence of FBT has more than doubled over the last decade. Clinicians remain unfamiliar with severe septic presentations of FBT when considering the etiologies of acute undifferentiated febrile syndromes. The diagnostic challenges of FBT include the nonspecific and variable nature of both history and physical examination and the lack of diagnostic testing that can provide clinically relevant information early in the course of infection. These barriers perpetuate misdiagnoses in critically ill patients and lead to delay in initiating appropriate antibiotics, which may contribute to preventable morbidity and mortality. This case series describes the clinical and diagnostic trajectories of three patients who developed FBT-associated multi-organ dysfunction. These patients achieved resolution of infection after receiving doxycycline in the context of a high clinical suspicion. Patients residing in FBT-endemic areas presenting with a febrile illness of unknown etiology with a suggestive constellation of hyponatremia, elevated transaminase levels, and thrombocytopenia should be suspected of having FBT. Clinicians should proceed to serologic testing with early doxycycline therapy for potential rickettsiosis. Familiarizing clinicians with the presentation of rickettsiosis-associated septic syndromes and its early and appropriate antibiotic treatment can provide lifesaving care and reduce health-care costs through prevention of the morbidity associated with FBT.
Author Notes
Authors’ addresses: Teresa A. Chueng, Department of Internal Medicine, Jackson Memorial Hospital, Miami, FL, E-mail: teresa.chueng@jhsmiami.org. Kristopher R. Koch, Department of Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, E-mail: kochk@uthscsa.edu. Gregory M. Anstead, Division of Infectious Diseases, Department of Infectious Diseases, University of Texas Health San Antonio, San Antonio, TX, and Medicine Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, San Antonio, TX, E-mail: anstead@uthscsa.edu. Apeksha N. Agarwal, Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, TX, E-mail: agarwala@uthscsa.edu. Christopher L. Dayton, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, E-mail: dayton@uthscsa.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Civen R, Ngo V, 2008. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis 46: 913–918.
-
2.
Afzal Z, Kallumadanda S, Wang F, Hemmige V, Musher D, 2017. Acute febrile illness and complications due to murine typhus, Texas, USA. Emerg Infect Dis 23: 1268–1273.
-
3.
Murray KO, Evert N, Mayes B, Fonken E, Erickson T, Garcia MN, Sidwa T, 2017. Typhus group rickettsiosis, Texas, USA, 2003–2013. Emerg Infect Dis 23: 645–648.
-
4.
Adjemian J, Parks S, McElroy K, Campbell J, Eremeeva ME, Nicholson WL, McQuiston J, Taylor J, 2010. Murine typhus in Austin, Texas, USA, 2008. Emerg Infect Dis 16: 412–417.
-
5.
California Department of Public Health–Department of Public Health Vector-Borne Disease Section, 2018. Human Flea-Borne Typhus Cases in California. Available at: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH Document Library/Flea-borneTyphusCaseCounts.pdf. Accessed March 3, 2018.
-
6.
Eremeeva ME et al. 2012. Two pathogens and one disease: detection and identification of flea-borne rickettsiae in areas endemic for murine typhus in California. J Med Entomol 49: 1485–1494.
-
7.
Pieracci EG, Evert N, Drexler NA, Mayes B, Vilcins I, Huang P, Campbell J, Behravesh CB, Paddock CD, 2017. Fatal flea-borne typhus in Texas: a retrospective case series, 1985–2015. Am J Trop Med Hyg 96: 1088–1093.
-
8.
Dumler JS, Taylor JP, Walker DH, 1991. Clinical and laboratory features of murine typhus in south Texas, 1980 through 1987. JAMA 266: 365–1370.
-
9.
Chaliotis G, Kritsotakis EI, Psaroulaki A, Tselentis Y, Gikas A, 2012. International journal of infectious diseases murine typhus in central Greece: epidemiological, clinical, laboratory, and therapeutic-response features of 90 cases. Int J Infect Dis 16: 591–596.
-
10.
Tsioutis C, Zafeiri M, Avramopoulos A, Prousali E, Miligkos M, Karageorgos SA, 2017. Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: a systematic review. Acta Trop 166: 16–24.
-
11.
Theunissen C, Cnops L, Van Esbroeck M, Huits R, Bottieau E, 2017. Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report. BMC Infect Dis 17: 273.
-
12.
Paris DH, Dumler JS, 2016. State of the art of diagnosis of rickettsial diseases: the use of blood specimens for diagnosis of scrub typhus, spotted fever group rickettsiosis, and murine typhus. Curr Opin Infect Dis 29: 433–439.
-
13.
Dumler JS, Walker DH, 1994. Diagnostic tests for Rocky Mountain spotted fever and other rickettsial diseases. Dermatol Clin 12: 25–36.
-
14.
Blanton LS, 2013. Rickettsial infections in the tropics and in the traveler. Curr Opin Infect Dis 26: 435–440.
-
15.
Bernabeu-Wittel M, Villanueva-Marcos JL, de Alarcón-González A, Pachón J, 1998. Septic shock and multiorganic failure in murine typhus. Eur J Clin Microbiol Infect Dis 17: 131–132.
-
16.
Sakamoto N, Nakamura-Uchiyama F, Kobayashi KI, Takasaki T, Ogasawara Y, Ando S, Iwabuchi S, Ohnishi K, 2013. Severe murine typhus with shock and acute respiratory failure in a Japanese traveler after returning from Thailand. J Travel Med 20: 50–53.
-
17.
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: 720–724.
-
18.
Stephens BE, Thi M, Alkhateb R, Agarwal A, Sharkey FE, Dayton C, Anstead GM, 2018. Case report: fulminant murine typhus presenting with status epilepticus and multi-organ failure: an autopsy case and a review of the neurologic presentations of murine typhus. Am J Trop Med Hyg 99: 306–309.
-
19.
Patel NJ, Caserta MP, DiSantis DJ, 2016. The “starry sky” liver. Ultrasound 14: 675–679.
-
20.
Chung JY, Hsu CC, Chen JH, Chen WL, Lin HJ, Guo HR, Huang CC, 2018. Geriatric influenza death (GID) score: a new tool for predicting mortality in older people with influenza in the emergency department. Sci Rep 8: 9312.
-
21.
Texas APR-DRG Grouper, 2018. Available at: https://rad.hhs.texas.gov/sites/rad/files/documents/hospital-svcs/2019/2019-hosp-aprdrg.pdf. Accessed August 14, 2018.
-
22.
HHSC Hospital Rate Analysis Department, 2018. All Patient Refined Diagnosis Related Group. Available at: https://rad.hhs.texas.gov/sites/rad/files/documents/hospital-svcs/2018/2018-hosp-urban-sda.pdf. Accessed August 14, 2018.
-
23.
Paoli CJ, Reynolds MA, Sinha M, Gitlin M, Crouser E, 2018. Epidemiology and costs of sepsis in the United States-an analysis based on timing of diagnosis and severity level. Crit Care Med 46: 1889–1897.
-
24.
Vohra RF, Walker DH, Blanton LS, 2018. Analysis of health-care charges in murine typhus: need for improved clinical recognition and diagnostics for acute disease. Am J Trop Med Hyg 98: 1594–1598.
-
25.
Singer M et al. 2016. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315: 801–810.
-
26.
Seymour CW et al. 2016. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315: 762–774.
-
27.
Balasubramanian P, Sharma N, Biswal M, Bhalla A, Kumar S, Kumar V, 2018. Critical illness scoring systems: sequential organ failure assessment, acute physiology and chronic health evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions. Indian J Crit Care Med 22: 706–710.
-
28.
Rhodes A et al. 2017. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock. Intensive Care Med 43: 304–377.
-
29.
Gou Y, Gao W, Yang H, Ma C, Sui S. 2016. De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: a meta-analysis. Heart Lung 45: 454–459.
-
30.
Newton PN et al. 2019. A prospective, open-label, randomized trial of doxycycline versus azithromycin for the treatment of uncomplicated murine typhus. Clin Infect Dis 68: 738–747.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 546 | 418 | 14 |
| Full Text Views | 768 | 16 | 0 |
| PDF Downloads | 192 | 20 | 0 |