Published Date: 2004-08-11 23:50:00
Subject: PRO/AH/EDR> Murine typhus - USA (TX)
Archive Number: 20040811.2220
MURINE TYPHUS - USA (TEXAS)
A ProMED-mail post
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International Society for Infectious Diseases
Date: Tue 10 Aug 2004
From: ProMED-mail <email@example.com>
Source: Corpus Christi Caller-Times [edited]
27 cases of flea-borne murine typhus reported
Nueces County is in the early stages of a murine typhus outbreak,
with at least 27 people who have suffered the 102 to 103-degree
fevers, severe headaches, and flu-like symptoms of the illness,
accordi ng to the Corpus Christi-Nueces County Health District.
In a normal year, 14 to 20 cases of typhus are reported in Nueces
County, and the last time there was an outbreak of this nature was
in the late 1980s, health district spokesman Eduardo Govea said.
"We're still investigating it right now," Govea said on Mon 9 Aug
2004. "We have clusters within the city and some sporadic cases
throughout the county as well."
Typhus is a bacteriological infection carried by infected fleas,
specifically, fleas found on cats, possums, and rats, according to
the Texas Department of Health. The infection can be treated with
antibiotics, but a vaccine doesn't exist, Govea said. Some cases
can be cleared up within a day, but it is possible to have typhus for a
month, he said.
5 days after the initial symptoms of nausea, high body
temperatures, and headaches, a person infected with typhus may
get a rash that starts on the trunk of the body and spreads to the
arms and legs, according to the Texas Department of Health.
Medical tests can confirm whether a person has typhus. If left
untreated, the disease could last for several months and could
require hospitalization, according to the health department.
The best preventive measure is to clean a yard so that rodents and
stray cats can't live there. Remove brush or trash, keep grass
mowed, and don't leave pet food out at night. It's also important to
treat for fleas before getting rid of rodents, because when the
rodents die, the fleas will try to live on household pets, or people,
according to the health department.
Cases of murine typhus in the United States occur almost
exclusively in Southern California and South Texas, said Greg Pye,
a zoonosis control specialist with the Texas Department of Health.
The annual number of reports of typhus in Texas has ranged from
22 to 53 between 1998 and 2002. The health department couldn't
immediately confirm the number of cases last year  or this
year . Most of the cases in Texas occur in Nueces and
Hidalgo counties, Pye said.
"There seems to be a lot more than usual in Nueces County this
year ," Pye said. "Whether there's more cases of typhus or
just a better job of reporting, is hard to figure out."
[Byline: Matthew Sturdevant]
[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 smoky 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 Texas, the increased number of cases this year 
deserves note. In the developed world, the infection is found along
the eastern coasts of the south Atlantic states in the USA, the
Caribbean, the Pacific coasts of the southwestern 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, in 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 disease, only 10 percent require
intensive care, but 1-4 percent die.
Diagnosis is based on serology. However, identification of
rickettsiae in smear or culture of skin lesions may be performed by
The typical adult therapy consists of doxycycline 100 mg BID for 3
to 5 days. However, some would prefer chloramphenicol (12.5
mg/kg QID for 3 to 5 days) for children.
High activity exists in the Rio Grande valley (southern Texas) and in
the Los Angeles area.
In the USA, 19 663 cases were reported during 1944 to 1953
(5401 in 1944); 812 during 1954 to 1963; 315 during 1964 to
1973; 588 during 1974 to 1983. 33 cases were reported from Los
Angeles during 1984 to 1988 (cats and opossums implicated as
reservoirs); 50 cases nationwide in 1990; 43 in 1991 (22 in
Texas); 28 in 1992 (18 in Texas); 25 in 1993. As of 1994, the
disease was no longer nationally notifiable. - Mod.LL]