Case Report: Cardiovascular Manifestations due to Flea-Borne Typhus

Christian Olivo-Freites Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California;

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Kusha Davar Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California;

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Oscar Gallardo-Huizar Internal Medicine Department, Olive View Medical Center, University of California, Los Angeles, California

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Tara Vijayan Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California;

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Ramee Younes Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California;

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ABSTRACT.

Flea-borne typhus is a vector-borne disease caused by Rickettsia typhi that occurs worldwide, except in Antarctica. In the United States, most cases are restricted to California, Hawaii, and Texas. The syndrome is characterized by nonspecific signs and symptoms: fever, headache, rash, arthralgia, cough, hepatosplenomegaly, diarrhea, and abdominal pain. Although flea-borne typhus can cause pulmonary, neurological, and renal complications, the cardiovascular system is rarely affected. We present a case of endocarditis resulting from flea-borne typhus diagnosed by blood microbial cell-free DNA testing that required valve replacement and antibiotic therapy for 6 months. In addition, we review 20 cases of presumed and confirmed cardiovascular manifestations resulting from flea-borne typhus in the literature.

Author Notes

Authors’ addresses: Christian Olivo-Freites, Kusha Davar, Tara Vijayan, and Ramee Younes, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, E-mails: christianolivofreites@gmail.com, kdavar@dhs.lacounty.gov, tvijayan@mednet.ucla.edu, and ryounes@mednet.ucla.edu. Oscar Gallardo-Huizar, Internal Medicine Department, Olive View Medical Center, University of California, Los Angeles, CA, E-mail: ogallardohuizar@dhs.lacounty.gov.

Address correspondence to Kusha Davar, 1200 North State St. A6137, Los Angeles, CA 90033. E-mail: kdavar@dhs.lacounty.gov
  • 1.

    Peniche Lara G , Dzul-Rosado KR , Zavala Velázquez JE , Zavala-Castro J , 2012. Murine typhus: clinical and epidemiological aspects. Colomb Med (Cali) 43: 175180.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Caravedo Martinez MA , Ramírez-Hernández A , Blanton LS , 2021. Manifestations and management of flea-borne rickettsioses. Res Rep Trop Med 12: 114.

  • 3.

    Blanton LS , 2019. The rickettsioses: a practical update. Infect Dis Clin North Am 33: 213229.

  • 4.

    Anstead GM , 2020. History, rats, fleas, and opossums: the ascendency of flea-borne typhus in the United States, 1910–1944. Trop Med Infect Dis 5: 37.

  • 5.

    Anstead GM , 2020. History, rats, fleas, and opossums: II. The decline and resurgence of flea-borne typhus in the United States, 1945–2019. Trop Med Infect Dis 6: 2.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    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: 1624.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Tran LT , Helms JL , Sierra-Hoffman M , Stevens ML , Deliz-Aguirre R , Castro-Lainez MT , Deliz RJ , 2019. Rickettsia typhi infection presenting as severe ARDS. IDCases 18: e00645.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Stafford IA , Centeno FH , Al Mohajer M , Parkerson G , Woc-Colburn L , Burgos-Lee AJ , Rac M , Dunn J , Muldrew K , 2020. Successful detection of unrecognized Rickettsia typhi in pregnancy using cell-free next-generation sequencing. Case Rep Obstet Gynecol 2020: 6767351.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Chaorattanakawee S , Korkusol A , Tippayachai B , Promsathaporn S , Poole-Smith BK , Takhampunya R , 2021. Amplicon-based next generation sequencing for rapid identification of Rickettsia and ectoparasite species from entomological surveillance in Thailand. Pathogens 10: 215.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Centeno FH , Lasco T , Ahmed AA , Al Mohajer M , 2021. Characteristics of Rickettsia typhi infections detected with next-generation sequencing of microbial cell-free deoxyribonucleic acid in a tertiary care hospital. Open Forum Infect Dis 8: ofab147.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    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: 738747.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Binford CH , Ecker HD , 1947. Endemic (murine) typhus: report of autopsy findings in three cases. Am J Clin Pathol 17: 797806.

  • 13.

    Lamotte M , Labrousse C , Rozenbaum H , Normand JP , 1965. Myopericarditis with relapses related to murine typhus. Sem Hop 41: 518522.

  • 14.

    Grand A , Gallet J , 1972. Murine typhus revealed by pericarditis. Arch Mal Coeur Vaiss 65: 611620.

  • 15.

    Moreno Castillo JL , Sánchez Román J , Pamies Andreu E , Morales Sandino M , Vázquez García F , Torronteras Santiago R , 1984. Pleuropericarditis caused by Rickettsia mooseri: an unusual manifestation of murine typhus. Rev Clin Esp 173: 125127.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Austin SM , Smith SM , Co B , Coppel IG , Johnson JE , 1987. Case report: serologic evidence of acute murine typhus infection in a patient with culture-negative endocarditis. Am J Med Sci 293: 320323.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 720724.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Silpapojakul K , Ukkachoke C , Krisanapan S , Silpapojakul K , 1991. Rickettsial meningitis and encephalitis. Arch Intern Med 151: 17531757.

  • 19.

    Buchs AE , Zimlichman R , Sikuler E , Goldfarb B , 1992. Murine typhus endocarditis. South Med J 85: 751753.

  • 20.

    Silpapojakul K , Chayakul P , Krisanapan S , Silpapojakul K , 1993. Murine typhus in Thailand: clinical features, diagnosis and treatment. Q J Med 86: 4347.

  • 21.

    Bernabeu-Wittel M , Pachón J , Alarcón 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    van Doorn HR , Lo-A-Njoe SM , Ottenkamp J , Pajkrt D , 2006. Widened coronary arteries in a feverish child. Pediatr Cardiol 27: 515518.

  • 23.

    Kim BS , Kim SY , Han SH , Park HK , Lee DH , Park JS , 2013. Delayed-onset complete atrioventricular block in a patient with murine typhus myocarditis. Korean J Med 84: 723.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Kao P-T , Lee C-M , Liu C-P , Lin H-C , Tseng H-K , 2003. Murine typhus with pneumonitis and pleuropericarditis: a case report. J Intern Med Taiwan 14: 301306.

  • 25.

    Chueng TA , Koch KR , Anstead GM , Agarwal AN , Dayton CL , 2019. Case report: early doxycycline therapy for potential rickettsiosis in critically ill patients in flea-borne typhus-endemic areas. Am J Trop Med Hyg 101: 863869.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Dean A , Asaithambi R , Neubauer HC , 2021. Murine typhus in 5 children hospitalized for multisystem inflammatory syndrome in children. Hosp Pediatr 11: e61e65.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Toy D , Vo C , Kwan WC , Shavelle DM , 2021. Fulminant myocarditis secondary to murine typhus mimicking acute coronary syndrome. J Cardiol Cases 24: 99101.

  • 28.

    Madan R , Muthukumar V , Premji S , Khan R , Schmidt RM , 2022. Murine typhus-induced myocarditis. Am J Med 135: e397e398.

  • 29.

    Blauwkamp TA et al., 2019. Analytical and clinical validation of a microbial cell-free DNA sequencing test for infectious disease. Nat Microbiol 4: 663674.

  • 30.

    Dumler JS , Taylor JP , Walker DH , 1991. Clinical and laboratory features of murine typhus in south Texas, 1980 through 1987. JAMA 266: 13651370.

  • 31.

    van der Vaart TW , van Thiel PPAM , Juffermans NP , van Vugt M , Geerlings SE , Grobusch MP , Goorhuis A , 2014. Severe murine typhus with pulmonary system involvement. Emerg Infect Dis 20: 13751377.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Shaked Y , Shpilberg O , Samra Y , 1994. Involvement of the kidneys in Mediterranean spotted fever and murine typhus. Q J Med 87: 103107.

  • 33.

    Leal-López VF , Arias-León JJ , Faccini-Martínez ÁA , Lugo-Caballero C , Quiñones-Vega C , Erosa-Gonzalez JM , Dzul-Rosado KR , 2020. Fatal murine typhus with hemophagocytic lymphohistiocytosis in a child. Rev Inst Med Trop São Paulo 62: e99.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Phetsouvanh R , Thojaikong T , Phoumin P , Sibounheuang B , Phommasone K , Chansamouth V , Lee SJ , Newton PN , Blacksell SD , 2013. Inter- and intra-operator variability in the reading of indirect immunofluorescence assays for the serological diagnosis of scrub typhus and murine typhus. Am J Trop Med Hyg 88: 932936.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Fowler VG Jr. et al., 2023. The 2023 Duke–International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: updating the modified Duke criteria. Clin Infect Dis 77: 518526.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Eichenberger EM et al., 2022. Microbial cell-free DNA identifies the causative pathogen in infective endocarditis and remains detectable longer than conventional blood culture in patients with prior antibiotic therapy. Clin Infect Dis 76: e1492e1500.

    • PubMed
    • Search Google Scholar
    • Export Citation
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