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Clinical, Laboratory, and Epidemiologic Features of Murine Typhus in 97 Texas Children
Sarah F. Whiteford, MD;
Jeffery P. Taylor, MPH;
J. Stephen Dumler, MD
Arch Pediatr Adolesc Med. 2001;155:396-400.
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.
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).
Corresponding author and reprints: J. Stephen Dumler, MD, Division
of Medical Microbiology, Department of Pathology, The Johns Hopkins University
School of Medicine, Meyer B1-193, 600 N Wolfe St, Baltimore, MD 21287 (e-mail: sdumler{at}jhmi.edu).
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