Endemic (murine) typhus is a flea-borne, rickettsial febrile illness caused by Rickettsia typhi. Over the past decade in Texas, R. typhi has been increasing with regards to the reported numbers of cases and geographic scope. In 2007, cases began to be reported from the Houston metropolitan area. Here, we describe a cohort of pediatric patients seen in a large, tertiary care children’s hospital in Houston, TX. We aimed to define the epidemiology, clinical presentation and relevant exposures in the affected population.
All children with a Rickettsial test ordered in the institution between 2007 and 2016 were included in this study. Of those with specimens submitted, we identified 24 positive patients who met clinical and serological criteria for a diagnosis of R. typhi. We used standardized forms for chart review and data collection, and descriptive statistics were used to analyze the data. This study was reviewed and approved by Baylor College of Medicine’s IRB.
Of the 24 confirmed positive case-patients, 58% were female; 50% were white and 41% were Hispanic. Ages ranged from 4 to 19 years, with an average of 11.3 years of age. The majority (75%) of patients had some relevant animal or environmental exposure, most commonly being dogs and cats. Only one patient reported exposure to an opossum, traditionally known as a reservoir in this region, and 20% reported recent flea bites. Only 16% had travelled outside of the Houston area, confirming local transmission. The most commonly reported symptoms were fever (91%), rash (45%), lack of appetite (37%), headache (33%), and vomiting (29%). The rash appearance was equally likely to be macular or papular in nature, most often involving the trunk and, more rarely, palms and soles.
In this study, we describe the clinical features of a newly emerging vector-borne infectious diseases in the Houston area. As is common with rickettsioses and illustrated by this case series, the symptoms are often nonspecific, requiring a high degree of clinical suspicion by the clinical provider. With the increase in reported cases and geographic expansion, we want to highlight the importance of raising physician awareness to identify and treat suspected cases.
J. Da Silva,
K. Murray, None
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