Published Date: 2003-07-02 23:50:00
Subject: PRO/AH/EDR> Murine typhus, human - USA (HI)
Archive Number: 20030702.1630
MURINE TYPHUS, HUMAN - USA (HAWAII)
A ProMED-mail post
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International Society for Infectious Diseases
Date: 1 Jul 2003
From: ProMED-mail <email@example.com>
Source: Star Bulletin [edited]
Number of typhus cases is up from last year
Murine typhus cases in Hawaii in 2003 have risen to 9 statewide, one
above the number for the same period of 2002. Typhus cases rose in
2002 to the highest levels since 1947, which was the highest nonwar
outbreak, according to state health officials.
Still, they said the numbers in 2003 are too small, and it is too
early to determine whether there is a trend that will top 2002's
total of 47. So far this year, murine typhus cases amount to 6 on
Maui -- 1 in Paia, 1 in Lahaina and 4 in Kihei -- 1 on Molokai in
Kaunakakai, and 2 on Oahu -- 1 in Waianae and 1 in Ewa Beach.
Dr. Paul Kitsutani, an official with the federal Centers for Disease
Control and Prevention working with the state, said 1 of the 9, an
Ewa Beach man who had a "moderately severe illness," required
Symptoms of murine typhus include fever, rash, body aches, and
headaches. The infection can be treated with antibiotics.
People typically contract murine typhus from fleas that first bite an
infected rodent, then a human being. The flea feces, carrying the
bacteria _Rickettsia typhi_, then enter through the bite in the skin.
State health officials said that other than 2002, when there were 47
confirmed cases of murine typhus statewide, an average of 4 or 5
cases occur annually. None of the 47 died, but 18 people were
hospitalized, including a Lahaina man who suffered encephalitis and
State vector control workers have been employing various strategies
to control the rodent population. In South Maui and Molokai, workers
have been placing poison oats in the fields. In Lahaina the oats have
been put into bait traps to avoid poisoning endangered nene geese.
Dr. Lorrin Pang, state health administrator on Maui, said state
workers have noticed a decrease in the number of mice in traps this
year in South Maui. Pang did not know the reason for the decrease in
mice. He said the rodents often begin to come out of the fields in
the fall when there is dry weather.
The number of confirmed typhus cases in 2002 reached its peak in
September with 11.
[Byline: Gary T. Kubota]
[There are 5 diseases with typhus literally or figuratively in their
names: epidemic typhus, Brill-Zinsser disease (recrudescent epidemic
typhus), murine typhus, scrub typhus, and typhoid (so-called because
it is typhus-like) The term typhus comes from the Greek, _typhein_ -
to smoke - which may refer to the smokey or clouded mental status
that patients present with.
Murine typhus, caused by _Rickettsia typhi_, is distributed widely
throughout the world, especially in the warm and humid coastal
environments of tropic and subtropical climes. Although clearly
endemic in Hawaii, the increased number of cases this year deserves
note. In the developed world, the infection is found along the
eastern coasts of south Atlantic states in the USA, the Caribbean,
and Pacific coasts of the southeastern and southwest USA as well as
Hawaii. In Europe, it is distributed along the Mediterranean coast
as well as the Atlantic and Mediterranean coasts of Africa. It is a
zoonosis is which rats function as the disease's asymptomatic
reservoir, and the Oriental rat flea _Xenopsylla cheopis_ is the most
common vector. Although generally coastal in distribution, the
disease may well spread away from the coast via major routes of
transportation. Although rickettsia-infected flea feces being rubbed
into a flea bite appears to be the major vehicle of transmission to
man, flea bites themselves and aerosolization of flea feces may
transmit infection as well.
Murine typhus is a relatively mild disease. Among patients admitted
to an acute care hospital with this diseases, only 10 percent require
an intensive care unit setting, and only 1-4 percent die.
Tetracyclines appear to remain the drug of choice in treatment. -