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Published Date: 2012-06-01 12:12:53
Subject: PRO/AH/EDR> Murine typhus - USA (02): (CA)
Archive Number: 20120601.1153052

MURINE TYPHUS - USA (02): (CALIFORNIA)
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Date: Tue 29 May 2012
Source: NBC Los Angeles [edited]
http://www.nbclosangeles.com/news/local/symptoms-treatment-typhus-orange-county-155417285.html

Health officials in Orange County [California] are working hard to stop a single incident of [murine] typhus from becoming an outbreak. But what is typhus and how do you spot it?

A child in Santa Ana [Santa Ana is the county seat and 2nd most populous city in Orange County, California] was hospitalized with the condition last month [April 2012], and although the child has since recovered, the county's animal control specialists are trying to trap feral cats near 2 schools in the area, Frances E Willard Intermediate School in the 1300 block of North Ross Street and El Sol Science and Arts Academy in the 1000 block of North Broadway.

It was the 2nd case of typhus in the Orange County this year [2012], according to Nicole Stanfield, spokeswoman for the county health department. Infections, once rare in Southern California, have been increasing steadily over the past 6 years, she said. "In 2006 we started seeing an increase, and every year the numbers have gone up," Stanfield said.

[Murine, also called endemic] typhus occurs when fleas that carry _Rickettsia typhi_ bite a person. These pests [fleas] live on feral animals, including rats, cats, skunks, raccoons, and opossums. Murine typhus has become more common in Southern California in recent years. [Murine typhus is similar to epidemic or human louse-borne typhus that is caused by _Rickettsia prowazekii_, but murine typhus is much milder and the fatality rate in untreated cases is under 2 percent. - Mod.ML] Prompt treatment with antibiotics will cure nearly all patients with murine typhus, according to the "Medline" website of the National Institutes of Health [http://www.nlm.nih.gov/medlineplus/ency/article/001363.htm.]

[Murine] typhus is characterized by very high fevers of 105 to 106 deg F [40.5-41 deg C], which may last as long as 2 weeks, according to NIH. Other symptoms include: abdominal pain, backache, diarrhea, and a dull, red rash that begins in the middle of the body and spreads, according to NIH. Sufferers may experience a hacking, dry cough, headache, joint and muscle pain, nausea, and vomiting.

To avoid infection, stay away from areas where there are rats, raccoons, opossums, skunks, or other carriers. If you or a child have been bitten [by fleas] and develop symptoms, call a doctor right away.

The illness is not related at all to typhoid fever.

[Byline: Sharon Bernstein]

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[The following is extracted from ProMED-mail post Murine typhus - USA: (TX) archive no: 20110607.1734:

"_Rickettsia_ are small obligate intracellular parasites that are maintained in animal and arthropod reservoirs and transmitted by arthropod vectors (ticks, fleas, lice, or mites) to humans. Murine typhus, which occurs throughout the world, is a flea-borne rickettsial disease caused by the _Rickettsia typhi_. Rats are the primary animal reservoir of _R. typhi_; however, other mammals, such as free-ranging cats, dogs, and opossums and their fleas can maintain this microorganism in areas where rats and rat fleas are absent (Azad AF, Radulovic S, Higgins JA, et al: Flea-borne rickettsioses: ecologic considerations. Emerg Infect Dis 1997; 3(3): 319-27; available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627639/).

"Humans are usually infected by contact with infected flea feces, either by inoculation into excoriated fleabites, inhalation, or ingestion. Symptoms include fever, headache, chills, vomiting, nausea, myalgias, and rash. The illness usually resolves within 3 weeks, even if untreated. However some patients are sick enough to be hospitalized in an intensive care unit and up to 4 percent of hospitalized patients will die from the infection. Treatment is doxycycline. Prevention is directed at control of flea vectors and animal reservoirs.

"Murine typhus occurs in the USA in southern Texas, southern California, and Hawaii. In 2008, 33 laboratory-confirmed cases of murine typhus occurred in Austin, Texas (see ProMED-mail post Murine typhus - USA (04): (TX) 2008-2009 20091120.3995). Illness ranged from mild to severe, with 73 percent of patients requiring hospitalization. Environmental investigation at the time suggested that opossums and domestic animals likely played a role in the maintenance and spread of _R. typhi_."

The following is extracted from ProMED-mail post Murine typhus - USA (03): (CA) archive no: 20110917.2831:

"What can people do to protect themselves from flea-borne typhus? Here are some tips offered by HCA [Orange County's Health Care Agency]:
- Treat pets regularly with flea-prevention medications.
- Avoid contact with rodents, opossums, feral cats, or other animals that may have fleas.
- Close openings to attics and crawl spaces in your home, and keep vents and screens in good repair to prevent animals from getting in.
- Report dead animals to your local Animal Control agency. OC [Orange County] Animal Care [OCAC] covers 17 OC cities, as well as unincorporated areas. For other cities, consult the OCAC website, http://www.OCPetInfo.com.
- Remove or trim overgrown vegetation or ground cover where wild animals may hide or nest.
- Keep trashcans covered and remove outdoor sources of food and water, like pet food and fallen fruit from trees."

Orange County is a county in the US state of California. As of the 2010 census, its population was 3 010 232, making it the 3rd most populous county in California, behind Los Angeles County and San Diego County and the 6th most populous county in the United States as of 2009 (http://en.wikipedia.org/wiki/Orange_County,_California). The county is known for its tourism. It is the home of such attractions as Disneyland. The county can be located on a map at http://en.wikipedia.org/wiki/File:Map_of_California_highlighting_Orange_County.svg and the state of California can be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/1r1d. - Mod.ML]

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