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Murine Typhus in South Texas Children

An 18-year Review

Howard, Ashley, DO*; Fergie, Jaime, MD†,‡

The Pediatric Infectious Disease Journal: November 2018 - Volume 37 - Issue 11 - p 1071–1076
doi: 10.1097/INF.0000000000001954
Original Studies

Background: Murine typhus is a zoonotic infection caused by Rickettsia typhi that remains endemic in South Texas. In 2003, only 9 Texas counties reported murine typhus compared with 41 counties in 2013.

Methods: A retrospective study of children discharged with a confirmed diagnosis of murine typhus from Driscoll Children’s Hospital between January 1998 and September 2016.

Results: Two hundred thirteen children (113 female) 3 months through 19 years of age (mean, 11.2 ± 4.5 years) were identified. Cases occurred throughout the year. Children were admitted after a mean of 7.7 ± 5.3 days of fever. The most common symptoms were fever (100%), poor appetite (71.9%), malaise/fatigue (69.0%) and headache (67.6%). The most common laboratory abnormalities were elevated C-reactive protein, hypoalbuminemia, elevated erythrocyte sedimentation rate, elevated transaminases and elevated band count with normal total white blood cell count. Children defervesced in a mean of 31.87 ± 21.36 hours after initiation of doxycycline. Hospitalization lasted for a mean of 2.7 ± 1.8 days when children were administered doxycycline within 24 hours of admission compared with, 4.1 ± 1.8 days, P ≤ 0.0001 when started later. Eleven patients (5.1%) were admitted to the pediatric intensive care unit and were older, P = 0.0009. No children died.

Conclusions: Murine typhus is endemic in South Texas. Children who were treated earlier with doxycycline had a shorter hospitalization than were those who began therapy later. Recognition of murine typhus is important to prevent delay in treatment and development of complications.

From the *Driscoll Children’s Hospital

Department of Pediatric Infectious Disease, Driscoll Children’s Hospital, Corpus Christi, Texas

Texas A&M University College of Medicine, Bryan, Texas.

Accepted for publication December 6, 2017.

The authors have no funding or conflicts of interest to disclose.

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Address for correspondence: Jaime Fergie, MD, Department of Pediatric Infectious Disease, Driscoll Children’s Hospital, 3533 S Alameda St, Corpus Christi, TX 78411. E-mail:

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