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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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

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: jaime.fergie@dchstx.org.

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