Rickettsia typhi

Murine typhus (R. typhi)

• Disease caused by the flea-borne Gram-negative intracellular bacterium Rickettsia typhi

Life Cycle

• Flea bits, flea poops, feces get rubbed into the bite wound
• Flea acquires infection from feeding on a rickettsemic host

Epidemiology

• Flea vector (Xenopsylla cheopis) with a rat reservoirs (Rattus spp.)
  • Also, cat flea vector (Ctenocephalides felis) in sourthern US
  • Possibly opossums as reservoirs
• Worldwide distribution
• In the US, most cases are in southern Texas and California

Clinical Presentation

• Incubation period of 1 to 2 weeks, but rarely remember flea exposure
• Fever, headache, nausea and vomiting are common, as well as myalgias
• Rash develops over the course
  • Usually described as maculopapular, sometimes with petechiae
  • On trunk, but can involve extremities
  • Rarely on palms and soles
• May have leukopenia and thrombocytopenia early in the course
• Elevated AST is common, as well as other liver enzymes
• Further nausea/vomiting and anorexia, cough, and hepatosplenomegaly may all develop
• Neurologic complications include confusion, seizures, and ataxia
• They often develop hypoalbuminemia and electrolyte abnormalities such as hyponatremia and hypocalcemia
• CSF shows aseptic meningitis
• 1 to 4% mortality
• Sort of like a milder version of R. prowazekii