Assistant Professor of Clinical Medicine Houston Methodist Houston, United States
Introduction: Murine typhus is a flea-borne illness caused by Rickettsia typhi. Fleas become lifelong carriers when they bite rats, cats, and opossums, and humans become infected when these fleas inoculate bite wounds with their feces. Disease occurs in warm temperate and tropical and subtropical climates across the world. In the United States, most cases occur in Hawaii, California, and Texas. The illness is usually mild and self-limiting, with individuals exhibiting flu-like symptoms of fever, chills, headache, myalgias, and rash. The CDC reports a significant increase in reported cases since 2008. Recent search supports pathogen reemergence and highlights cases of life threatening disease. In this case report, we present a case of murine typhus causing severe multi-organ failure.
Description: A 44 year old previously healthy female presented to the emergency department with a week long history of cough, fever, and chills. She was admitted to the ICU for septic shock secondary to multifocal pneumonia and treated with vasopressors and broad spectrum antibiotics. Initial infectious workup was unrevealing of a source of infection and over the next few days her condition worsened. She developed severe ARDS necessitating emergency cricothyroidotomy, as well as CRRT and supportive blood product transfusions for DIC secondary to renal and liver failure respectively. Additional history and serologic workup revealed increasing IgM levels of Rickettsia typhi and antimicrobials were tailored to appropriately treat the illness. She began to show significant improvement in her condition and was eventually discharged home a few weeks later with close specialty follow up. She still, however, remains trach dependent and on disability.
Discussion: This case illustrates the severity of disease caused by R. typhi. Although symptoms are usually mild, there are a growing number of life-threatening and fatal cases. Recognizing exposures and understanding the clinical manifestations of the disease could aid in early diagnosis and treatment, thus preventing known pulmonary, cardiac, hepatic, hematologic, and renal complications of the disease, and decreasing morbidity and mortality. Epidemiological interventions such as community education and vector control are also needed to mitigate disease.
