Murine typhus

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Murine typhus
Chest Xray 40 yr old male acute respiratory distress syndrome as a complication of murine typhus. 13-1421-F1.jpg
Chest Xray of a 40 yr old male in acute respiratory distress syndrome as a complication of murine typhus
Specialty Infectious disease

Murine typhus (also called endemic typhus) is a form of typhus transmitted by fleas (Xenopsylla cheopis), usually on rats. (This is in contrast to epidemic typhus, which is usually transmitted by lice.) Murine typhus is an under-recognized entity, as it is often confused with viral illnesses. Most people who are infected do not realize that they have been bitten by fleas.

Typhus group of infectious diseases

Typhus, also known as typhus fever, is a group of infectious diseases that include epidemic typhus, scrub typhus and murine typhus. Common symptoms include fever, headache, and a rash. Typically these begin one to two weeks after exposure.

Flea order of insects

Flea, the common name for the order Siphonaptera, includes 2,500 species of small flightless insects that survive as external parasites of mammals and birds. Fleas live by consuming blood or hematophagy, from their hosts. Adult fleas grow to about 3 mm or .12 in long, are usually brown, and have bodies that are "flattened" sideways, or narrow, enabling them to move through their host's fur or feathers. They lack wings, but have strong claws preventing them from being dislodged; mouthparts adapted for piercing skin and sucking blood, and hind legs extremely well adapted for jumping. They are able to leap a distance of some 50 times their body length, a feat second only to jumps made by another group of insects, the superfamily of froghoppers. Fleas' larvae are worm-like with no limbs; they have chewing mouthparts and feed on organic debris left on their host's skin.

Rat several genera of rodents

Rats are various medium-sized, long-tailed rodents. Species of rats are found throughout the order Rodentia, but stereotypical rats are found in the genus Rattus. Other rat genera include Neotoma, Bandicota and Dipodomys.

Contents

Signs and symptoms

Symptoms of endemic typhus include headache, fever, muscle pain, joint pain, nausea and vomiting. 40–50% of patients will develop a discrete rash six days after the onset of signs. Up to 45% will develop neurological signs such as confusion, stupor, seizures or imbalance.

Myalgia, or muscle pain, is a symptom of many diseases and disorders. The most common causes are the overuse or over-stretching of a muscle or group of muscles. Myalgia without a traumatic history is often due to viral infections. Longer-term myalgias may be indicative of a metabolic myopathy, some nutritional deficiencies or chronic fatigue syndrome.

Arthralgia literally means joint pain; it is a symptom of injury, infection, illnesses or an allergic reaction to medication.

Nausea medical symptom or condition

Nausea is an unpleasant, diffuse sensation of unease and discomfort, often perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged, and has been described as placing discomfort on the chest, upper abdomen, or back of the throat.

Symptoms may resemble those of measles, rubella, or possibly Rocky Mountain spotted fever. These symptoms are likely caused by a vasculitis caused by the rickettsia.

Measles viral disease affecting humans

Measles is a highly contagious infectious disease caused by the measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104.0 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Rubella, which is sometimes called German measles, and roseola are different diseases caused by unrelated viruses.

Rubella human viral disease

Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild with half of people not realizing that they are infected. A rash may start around two weeks after exposure and last for three days. It usually starts on the face and spreads to the rest of the body. The rash is sometimes itchy and is not as bright as that of measles. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. In adults joint pain is common. Complications may include bleeding problems, testicular swelling, and inflammation of nerves. Infection during early pregnancy may result in a child born with congenital rubella syndrome (CRS) or miscarriage. Symptoms of CRS include problems with the eyes such as cataracts, ears such as deafness, heart, and brain. Problems are rare after the 20th week of pregnancy.

Rocky Mountain spotted fever human disease

Rocky Mountain spotted fever (RMSF) is a bacterial disease spread by ticks. It typically begins with a fever and headache, which is followed a few days later with the development of a rash. The rash is generally made up of small spots of bleeding and starts on the wrists and ankles. Other symptoms may include muscle pains and vomiting. Long-term complications following recovery may include hearing loss or loss of part of an arm or leg.

Causes

It is caused by the bacteria Rickettsia typhi , and is transmitted by the fleas that infest rats. While rat fleas are the most common vectors, cat fleas and mouse fleas are less common modes of transmission. These fleas are not affected by the infection. Human infection occurs because of flea-fecal contamination of the bites on human skin. Rats, cats, opossums maintain the rickettsia colonization by providing it with a host for its entire life cycle. Rats can develop the infection, and help spread the infection to other fleas that infect them, and help multiply the number of infected fleas that can then infect humans.

Rickettsia typhi is a species of infectious bacterium of the genus Rickettsia; it is the causative agent of Murine typhus.

Less often, endemic typhus is caused by Rickettsia felis and transmitted by fleas carried by cats or opossums.

Rickettsia felis is a species of bacterium, the pathogen that causes cat-flea typhus in humans. In cats the disease is known as flea-borne spotted fever. Rickettsia felis also is regarded as the causative organism of many cases of illnesses generally classed as fevers of unknown origin in humans in Africa.

Opossum family of mammals

The opossum is a marsupial of the order Didelphimorphia endemic to the Americas. The largest order of marsupials in the Western Hemisphere, it comprises 103 or more species in 19 genera. Opossums originated in South America and entered North America in the Great American Interchange following the connection of the two continents. Their unspecialized biology, flexible diet, and reproductive habits make them successful colonizers and survivors in diverse locations and conditions. The animal is also known as a possum, particularly in North America.

In the United States of America, murine typhus is found most commonly in southern California, [1] Texas and Hawaii. In some studies, up to 13% of children were found to have serological evidence of infection. [2]

Diagnosis

As of 2014, early diagnosis continued to be based on clinical suspicion, and treatment of the disease is indicated even before laboratory results confirm its presence. Because of the lag between the onset of infection and the appearance of antibodies in a blood test, serologic tests are merely confirmatory and retrospective. Weil-Felix agglutination reactions are not sensitive to the disease. Indirect fluorescence antibody assays that are specific to R. typhi antigens are the recommended route for detection and diagnosis: diagnostic titers are present in half of all cases within the first week of infection and in nearly all cases by day-15. The sharing of antigens by rickettsiae means routine serologic evaluation will not distinguish between murine typhus and epidemic typhus. Bacterial cultures are rarely performed because although they are highly accurate for diagnosis, the biohazard risk of generating them is often considered too high. [3]

Treatment and prognosis

The disease can be fatal if left untreated, but endemic typhus is highly treatable with antibiotics. Most people recover fully, but death may occur in the elderly, severely disabled or patients with a depressed immune system. The most effective antibiotics include tetracycline and chloramphenicol. In United States, CDC recommends solely doxycycline. [4]

See also

Related Research Articles

Typhoid fever A bacterial infectious disorder contracted by consumption of food or drink contaminated with Salmonella typhi. This disorder is common in developing countries and can be treated with antibiotics.

Typhoid fever, also known simply as typhoid, is a bacterial infection due to Salmonella typhi that causes symptoms. Symptoms may vary from mild to severe and usually begin six to thirty days after exposure. Often there is a gradual onset of a high fever over several days; weakness, abdominal pain, constipation, headaches, and mild vomiting also commonly occur. Some people develop a skin rash with rose colored spots. In severe cases there may be confusion. Without treatment, symptoms may last weeks or months. Diarrhea is uncommon. Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. Typhoid fever is a type of enteric fever, along with paratyphoid fever.

Infection invasion of a host by disease-causing organisms

Infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce. Infectious disease, also known as transmissible disease or communicable disease, is illness resulting from an infection.

Epidemic typhus Human disease

Epidemic typhus is a form of typhus so named because the disease often causes epidemics following wars and natural disasters. The causative organism is Rickettsia prowazekii, transmitted by the human body louse.

Infectious mononucleosis common viral infectious disease

Infectious mononucleosis, also known as glandular fever, is an infection usually caused by the Epstein–Barr virus (EBV). Most people are infected by the virus as children, when the disease produces few or no symptoms. In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and tiredness. Most people recover in two to four weeks; however, feeling tired may last for months. The liver or spleen may also become swollen, and in less than one percent of cases splenic rupture may occur.

Psittacosis disease

Psittacosis—also known as parrot fever, and ornithosis—is a zoonotic infectious disease in humans caused by a bacterium called Chlamydophila psittaci and contracted from infected parrots, such as macaws, cockatiels, and budgerigars, and pigeons, sparrows, ducks, hens, gulls and many other species of birds. The incidence of infection in canaries and finches is believed to be lower than in psittacine birds.

Trench fever is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Macedonia, Mesopotamia, Russia and Egypt in World War I. Three noted sufferers during WWI were the authors J. R. R. Tolkien, A. A. Milne, and C. S. Lewis. From 1915 to 1918 between one-fifth and one-third of all British troops reported ill had trench fever while about one-fifth of ill German and Austrian troops had the disease. The disease persists among the homeless. Outbreaks have been documented, for example, in Seattle and Baltimore in the United States among injection drug users and in Marseille, France, and Burundi.

Leptospirosis human disease

Leptospirosis is an infection caused by corkscrew-shaped bacteria called Leptospira. Signs and symptoms can range from none to mild such as headaches, muscle pains, and fevers; to severe with bleeding from the lungs or meningitis. If the infection causes the person to turn yellow, have kidney failure and bleeding, it is then known as Weil's disease. If it also causes bleeding into the lungs then it is known as severe pulmonary hemorrhage syndrome.

Scrub typhus form of typhus caused by the intracellular parasite Orientia tsutsugamushi

Scrub typhus or bush typhus is a form of typhus caused by the intracellular parasite Orientia tsutsugamushi, a Gram-negative α-proteobacterium of family Rickettsiaceae first isolated and identified in 1930 in Japan.

<i>Rickettsia rickettsii</i> species of prokaryote

Rickettsia rickettsii is a gram-negative, intracellular, coccobacillus bacterium that is around 0.8 to 2.0 micrometers long. R. rickettsi is the causative agent of Rocky Mountain spotted fever. R. rickettsii is one of the most pathogenic Rickettsia strains. It affects a large majority of the Western Hemisphere and small portions of the Eastern Hemisphere.

Tick-borne diseases, which afflict humans and other animals, are caused by infectious agents transmitted by tick bites. Tick-borne illnesses are caused by infection with a variety of pathogens, including rickettsia and other types of bacteria, viruses, and protozoa. Because individual ticks can harbor more than one disease-causing agent, patients can be infected with more than one pathogen at the same time, compounding the difficulty in diagnosis and treatment. As of 2016, 16 tick-borne diseases of humans are known.

Bartonellosis is an infectious disease produced by bacteria of the genus Bartonella. Bartonella species cause diseases such as Carrión´s disease, trench fever, cat-scratch disease, bacillary angiomatosis, peliosis hepatis, chronic bacteremia, endocarditis, chronic lymphadenopathy, and neurological disorders.

The Weil–Felix test is an agglutination test for the diagnosis of rickettsial infections. It was first described in 1916. By virtue of its long history and of its simplicity, it has been one of the most widely employed tests for rickettsia on a global scale, despite being superseded in many settings by more sensitive and specific diagnostic tests.

Paratyphoid fever bacterial infection caused by one of the three types of Salmonella enterica

Paratyphoid fever, also known simply as paratyphoid, is a bacterial infection caused by one of the three types of Salmonella enterica. Symptoms usually begin 6–30 days after exposure and are the same as those of typhoid fever. Often, a gradual onset of a high fever occurs over several days. Weakness, loss of appetite, and headaches also commonly occur. Some people develop a skin rash with rose-colored spots. Without treatment, symptoms may last weeks or months. Other people may carry the bacteria without being affected; however, they are still able to spread the disease to others. Both typhoid and paratyphoid are of similar severity. Paratyphoid and typhoid fever are types of enteric fever.

Relapsing fever is a vector-borne disease caused by infection with certain bacteria in the genus Borrelia, which are transmitted through the bites of lice or soft-bodied ticks.

Globalization, the flow of information, goods, capital, and people across political and geographic boundaries, allows infectious diseases to rapidly spread around the world, while also allowing the alleviation of factors such as hunger and poverty, which are key determinants of global health. The spread of diseases across wide geographic scales has increased through history. Early diseases that spread from Asia to Europe were bubonic plague, influenza of various types, and similar infectious diseases.

A rickettsiosis is a disease caused by intracellular bacteria.

<i>Orientia tsutsugamushi</i> species of prokaryote

Orientia tsutsugamushi is a mite-borne bacterium belonging to the family Rickettsiaceae and is responsible for a disease called scrub typhus in humans. It is a natural and an obligate intracellular parasite of mites belonging to the family Trombiculidae. With a genome of only 2.4–2.7 Mb, it has the most repeated DNA sequences among bacterial genomes sequenced so far. The disease, scrub typhus, occurs when infected mite larvae accidentally bite humans. Primarily indicated by undifferentiated febrile illnesses, the infection can be complicated and often fatal.

African tick bite fever spotted fever that has material basis in Rickettsia africae, which is transmitted by ticks

African tick bite fever (ATBF) is a bacterial infection spread by the bite of a tick. Symptoms may include fever, headache, muscles pains, and a rash. At the site of the bite there is typically a red skin sore with a dark center. Onset usually occur 4–10 days after the bite. Complications are rare, however may include joint inflammation. Some people do not develop symptoms.

References

  1. "Murine (endemic) Typhus" (PDF). California Department of Public Health. Retrieved 30 May 2012.
  2. The Pediatric Infectious Disease Journal (Impact Factor: 3.57). 07/2000; 19(6):535−8.
  3. John E. Bennett; Raphael Dolin; Martin J. Blaser (2014-09-02). Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases E-Book. Elsevier Health Sciences. p. 2223. ISBN   978-0-323-26373-3.
  4. "Murine Typhus". Centers for Disease Control and Prevention. 7 March 2017. Retrieved 15 July 2017.
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