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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, P = 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; P = 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.
Financial support: This study was supported by grants from a foundation of the Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung Medical University (KMKH-96-013), and the Department of Health, Executive Yuan, Taiwan (DOH101-TD-B–111-002).
Disclosure: None of the authors have any conflicts of interest.
Authors' addresses: Ko Chang, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Hsiao Kang District, Kaohsiung 812, Taiwan, E-mail: email@example.com. Yen-Hsu Chen, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, E-mail: firstname.lastname@example.org. Nan-Yao Lee, Hsin-Chun Lee, Chia-Ming Chang, Chi-Jung Wu, and Wen-Chien Ko, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, E-mails: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Chun-Yu Lin, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, E-mail: firstname.lastname@example.org. Jih-Jin Tsai, Division of Infectious Diseases, Department of Internal Medicine, and College of Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; and Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, E-mail: email@example.com. Po-Liang Lu, Tun-Chieh Chen, and Wei-Ru Lin, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Hsiao-Chen Hsieh, Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; and Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Hsiao Kang District, Kaohsiung 812, Taiwan, E-mail: email@example.com. Ping-Chang Lai, Section of Infectious Diseases, Department of Internal Medicine, Tian-Sheng Memorial Hospital, No. 210, Section 1, Donggang Township, Pingtung County 928, Taiwan, E-mail: firstname.lastname@example.org. Chung-Hsu Lai, Section of Infectious Disease, Department of Internal Medicine, E-Da Hospital/I-Shou University, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung 824, Taiwan, E-mail: email@example.com.