as a common cause of fever of intermediate duration: a 17 year study in the South of Spain.
A confirmed case of murine typhus
was defined as having compatible signs and symptoms and seroconversion (diagnostic cutoff of 1:64) or a 4-fold increase in IgG titer against R.
In agreement with infectious disease practitioners and the World Health Organization (WHO) Collaborating Centre for Rickettsial Diseases, we chose to research murine typhus
only in cases of fever of unknown origin lasting >7 days.
To determine prevalence of such cases, we conducted a search of published studies mentioning pulmonary manifestations of murine typhus
(details in the online Technical Appendix, http://wwwnc.
has been reemerging in southeastern Mexico for the past 6 years (3,7).
was diagnosed on the basis of PCR amplification and immunofluorescent assay for antibodies to R.
is found throughout the world, widely distributed in subtropical and tropical regions, and is most apparent in port cities with large rat populations (2,4), which provide a reservoir for the pathogen and its main vector, the rat flea (Xenopsylla cheopsis).
To the Editor: An outbreak of murine typhus
caused by Rickettsia typhi was confirmed among persons attending a 51-acre drug detoxification program 2.
Sentinel studies in Malaysia (1), Thailand (2), India (3), Laos (4), and Nepal (5) suggest that scrub and murine typhus
are frequent and that misdiagnosis as enteric fever results in ineffective therapy (5).
typhi, primarily transmitted by the oriental rat flea (Xenopsylla cheopis), has a worldwide distribution and causes murine typhus
in humans (2).
Among patients with fever in Nepal, murine typhus
and scrub typhus are frequently described (1), but tick-borne rickettsioses remain underinvestigated.
Alternative vectors for rickettsiae are well known, including fleas as vectors for murine typhus