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March 2001

Clinical, Laboratory, and Epidemiologic Features of Murine Typhus in 97 Texas Children

Author Affiliations

From the Department of Pathology, University of Maryland School of Medicine, Baltimore (Dr Whiteford); the Texas Department of Health, Austin (Mr Taylor); and the Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore (Dr Dumler).

Arch Pediatr Adolesc Med. 2001;155(3):396-400. doi:10.1001/archpedi.155.3.396

Objective  To document the clinical, laboratory, and epidemiologic characteristics of pediatric patients with murine typhus.

Design  Pediatric patients were diagnosed using serologic testing, and clinical, laboratory, and epidemiologic data were retrospectively reviewed.

Setting  Of 97 patients, 77 (79%) were identified and treated as inpatients and 20 (21%) were treated as outpatients; most resided in south Texas.

Patients  Between 1979 and 1996, medical records and patient-physician interviews were available for 97 patients aged 16 years and younger with murine typhus.

Main Outcome Measures  The frequency of clinical symptoms and signs, abnormal laboratory findings, epidemiologic findings, and measures of disease severity were determined.

Results  The clinical triad of fever, headache, and rash occurred in only 43 (49%) of 87 pediatric patients throughout the illness. Musculoskeletal symptoms were experienced by 43% of patients, whereas gastrointestinal tract symptoms (nausea, vomiting, anorexia, and diarrhea) occurred in 77%. Systemic involvement was evident by the frequent occurrence of abnormal laboratory findings referable to multiple organ systems, including the liver, kidney, blood, and central nervous system.

Conclusions  Pediatric infection by Rickettsia typhi usually causes mild to moderate systemic illness. In children, the median duration of illness was 12 days (range, 5-29 days), but severe complications were rare. Length of illness was significantly related to the initial diagnosis, whereas the interval to defervescence was related to therapy with a tetracycline or chloramphenicol. Early recognition and treatment is important to prevent prolonged morbidity.